Preserved periprosthetic bone stock at 5 years post-operatively with uncemented short hip stem in both collared and collarless version

Ola Belfrage, Erik Weber, Martin Sundberg, Gunnar Flivik, Ola Belfrage, Erik Weber, Martin Sundberg, Gunnar Flivik

Abstract

Introduction: Previous bone density studies have generally shown bone resorption around both cemented and uncemented total hip arthroplasty (THA) stems. This is presumed to be due to stress shielding. Short stems have been introduced partly to preserve bone in the proximal femur by a more physiological loading of the bone. The purpose of this study was to evaluate bone remodeling around a short, fully hydroxyapatite-coated titanium stem that comes in a collared and collarless version.

Patients and methods: A prospective cohort of 50 patients included in a study evaluating the Furlong Evolution stem has been followed for 5 years. Examination was done with dual energy X-ray absorptiometry (DXA) postoperatively, at 1, 2 and 5 years. Clinical outcome was followed with radiography and both general and hip specific outcome measures.

Results: The two versions of the stem behaved similarly regarding bone remodeling. After an initial decrease up to 1 year, bone mineral density (BMD) increased in all Gruen zones up to 2 years and at 5 years bone stock was still preserved compared with postoperatively (net BMD + 1.2% (95% CI - 0.4 to 2.8)). Increase in BMD occurred mainly in the greater trochanter and distally around the stem with a decrease in the calcar area. Both versions showed excellent clinical outcome up to 5 years.

Conclusion: This short stem seems to preserve proximal bone stock up to 5 years, exhibiting similar behaviour both with and without a collar.

Trial registration number and date of registration: ClinicalTrials.gov, (identifier: NCT01894854). July 10, 2013.

Keywords: Bone density; DXA; Short stem THA; THA.

Conflict of interest statement

GF had paid presentation at symposium with JRI, otherwise the authors have no conflicts of interest related to this work.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Stem design in lateral view, the collared and the collarless version with 133-degree neck shaft angle
Fig. 2
Fig. 2
CONSORT flow diagram
Fig. 3
Fig. 3
Net BMD vs. time
Fig. 4
Fig. 4
Radiograph demonstrating the seven Gruen zones. Graphs represent the change in BMD in percentage (y-axis) over time in years (x-axis). Blue = collarless; red = collared

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