Influence of Femoral Component Design on Proximal Femoral Bone Mass After Total Hip Replacement: A Randomized Controlled Trial

Pablo A Slullitel, Mohit M Mahatma, Mohsen Farzi, George Grammatopoulos, J Mark Wilkinson, Paul E Beaulé, Pablo A Slullitel, Mohit M Mahatma, Mohsen Farzi, George Grammatopoulos, J Mark Wilkinson, Paul E Beaulé

Abstract

Background: In this randomized controlled trial (RCT), we compared bone remodeling and bone turnover between 2 total hip arthroplasty implants-the short, proximally porous-coated Tri-Lock Bone-Preservation Stem and a conventional, fully-coated Corail prosthesis-over a 2-year postoperative period.

Methods: Forty-six participants received the Tri-Lock prosthesis and 40 received the Corail prosthesis. At baseline, the 2 groups had similar demographics, proximal femoral bone mineral density (BMD), bone turnover markers, radiographic canal flare index, and patient-reported outcome measure (PROM) scores. Outcomes were measured at weeks 26, 52, and 104.

Results: Loss of periprosthetic bone, measured by high-sensitivity dual x-ray absorptiometry region-free analysis (DXA-RFA), was identified at the calcar and proximal-lateral aspect of the femur in both prosthesis groups (p < 0.05). However, the conventional prosthesis was associated with a smaller reduction in BMD compared with the bone-preservation prosthesis (p < 0.001). This effect was most prominent in the region of the femoral calcar and greater trochanter. A small gain in BMD was also identified in some areas, and this gain was greater with the conventional than the bone-preservation prosthesis (p < 0.001). The 2 groups had similar changes in bone turnover markers and improvement in PROM scores over the study period (p > 0.05). The adverse-event rate was also similar between the groups (p > 0.05).

Conclusions: This RCT shows that prostheses intended to preserve proximal femoral bone do not necessarily perform better in this regard than conventional cementless designs. DXA-RFA is a sensitive tool for detecting spatially complex patterns of periprosthetic bone remodeling.

Level of evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Conflict of interest statement

Disclosure: This project was funded by DePuy Synthes, a part of Johnson & Johnson Medical Products, a division of Johnson & Johnson Inc. The funder, which manufactures all the prostheses studied in this work, took no part in the design or conduct of the trial, the analysis or interpretation of the results, or the preparation of the manuscript. On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked “yes” to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work (http://links.lww.com/JBJS/G170).

Copyright © 2020 by The Journal of Bone and Joint Surgery, Incorporated.

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