Low BMD affects initial stability and delays stem osseointegration in cementless total hip arthroplasty in women: a 2-year RSA study of 39 patients

Hannu T Aro, Jessica J Alm, Niko Moritz, Tatu J Mäkinen, Petteri Lankinen, Hannu T Aro, Jessica J Alm, Niko Moritz, Tatu J Mäkinen, Petteri Lankinen

Abstract

Background and purpose: Immediate implant stability is a key factor for success in cementless total hip arthroplasty (THA). Low bone mineral density (BMD) and age-related geometric changes of the proximal femur may jeopardize initial stability and osseointegration. We compared migration of hydroxyapatite-coated femoral stems in women with or without low systemic BMD.

Patients and methods: 61 female patients with hip osteoarthritis were treated with cementless THA with anatomically designed hydroxyapatite-coated femoral stems and ceramic-ceramic bearing surfaces (ABG-II). Of the 39 eligible patients between the ages of 41 and 78 years, 12 had normal systemic BMD and 27 had osteopenia or osteoporosis. According to the Dorr classification, 21 had type A bone and 18 had type B. Translational and rotational migration of the stems was evaluated with radiostereometric analysis (RSA) up to 2 years after surgery.

Results: Patients with low systemic BMD showed higher subsidence of the femoral stem during the first 3 months after surgery than did those with normal BMD (difference = 0.6, 95% CI: 0.1-1.1; p = 0.03). Low systemic BMD (odds ratio (OR) = 0.1, CI: 0.006-1.0; p = 0.02), low local hip BMD (OR = 0.3, CI: 0.1-0.7; p = 0.005) and ageing (OR = 1.1, CI: 1.0-1.2; p = 0.02) were risk factors for delayed translational stability. Ageing and low canal flare index were risk factors for delayed rotational stabilization (OR = 3, CI: 1.1-9; p = 0.04 and OR = 1.1, CI: 1.0-1.2; p = 0.02, respectively). Harris hip score and WOMAC score were similar in patients with normal systemic BMD and low systemic BMD.

Interpretation: Low BMD, changes in intraosseous dimensions of the proximal femur, and ageing adversely affected initial stability and delayed osseointegration of cementless stems in women.

Figures

Figure 1.
Figure 1.
Study design.
Figure 2.
Figure 2.
A. The ABG-II stem with proximal HA coating and 3 medial tantalum RSA markers (arrows). There were 2 additional RSA markers on the shoulder of the stem and 1 marker in the distal tip. B. Schematic drawing of the prosthesis with tantalum RSA markers in the prosthesis and in the surrounding bone, with the coordinate system for RSA analysis of 3D micromotion of the implant.
Figure 3.
Figure 3.
Stem migration determined by RSA in women with normal or low systemic BMD. A. Total translational migration expressed as translation vector. B. Total rotational migration expressed as rotation vector. The values represent mean (SD).

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Source: PubMed

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