Intra-operative Clodronate Rinsing Improves the Integration of the Femoral Stem in a Prospective, Double-blinded, Randomized, Placebo-controlled Clinical RSA-study

Background: Periprosthetic bone loss after Total Hip Arthroplasty (THA), detected as an early migration of the prosthesis may predict later loosening of the implant. Objective: We hypothesized that intra-operative bisphosphonate rinsing would reduce bone resorption after THA. It might therefore be possible to achieve better early fixation of the implant. Methods: Nineteen patients suffering from arthrosis were recruited in a prospective, double-blinded, randomized, placebo-controlled clinical pilot trial. Patients were operated with an uncemented Bimetric stem using tantalum markers. The femoral proximal intramedullary canal was rinsed with 1mM clodronate in nine patients and with saline in 10 patients. These patients were followed for two years using radiostereometric analysis (RSA), dual energy x-ray absorptiometry (DXA) and the Harris Hip Score (HHS). Results: We did not found any significant differences between the study groups with regards to the primary output measures (maximum total point motion, MTPM). However, there was evidence that clodronate could affect periprosthetic bone quality; a beneficial effect in BMD in Gruen zone 3 during the two-year follow-up was observed, BMD decreased less in the clodronate group (p = 0.02). The maximal x-translation of the stem at 3-24 months was significantly two-fold, being higher in the placebo group (p = 0.02). The baseline BMD and the maximal total point motion (MTPM) at 3-24 months showed a positive correlation in the clodronate group and a negative correlation in the placebo group. Conclusion: In conclusion, further studies with larger patient groups and longer follow-up periods are needed to estimate the clinical importance of these findings and further to prove if an intraoperative clodronate rinsing prior to application of femoral stem during THA can prevent periprosthetic bone loss. Clinical Trial Registration No.: NCT03803839

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Periprosthetic bone loss after insertion of an uncemented, customized femoral stem and an uncemented anatomical stem

Acta Orthopaedica ◽

10.3109/17453674.2011.588860 ◽

2011 ◽

Vol 82 (4) ◽

pp. 410-416 ◽

Cited By ~ 31

Author(s):

Mona Nysted ◽

Pål Benum ◽

Jomar Klaksvik ◽

Olav Foss ◽

Arild Aamodt

Keyword(s):

Bone Loss ◽

Femoral Stem ◽

Periprosthetic Bone ◽

Periprosthetic Bone Loss

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Radiostereometric migration analysis of the Cerafit femoral stem: 28 patients followed for 2 years

Biomedical Engineering / Biomedizinische Technik ◽

10.1515/bmt-2015-0004 ◽

2016 ◽

Vol 61 (3) ◽

pp. 291-298 ◽

Cited By ~ 3

Author(s):

Franz Tschunko ◽

Benedikt Wagner ◽

Yutong Hong ◽

Stephan Söder ◽

Rainer Wölfel ◽

...

Keyword(s):

Clinical Outcome ◽

Femoral Stem ◽

Harris Hip Score ◽

Radiostereometric Analysis ◽

Distal Migration ◽

Point Motion ◽

Migratory Pattern ◽

Migration Analysis ◽

Total Point

Abstract Radiostereometric analysis (RSA) is the gold standard evaluating micromovements after total hip arthroplasty. The aim of this study was to investigate the migratory pattern of an uncemented femoral stem during the first 2 years after surgery. We followed 28 patients with a mean age of 57 (SD 13) years for the first two postoperative years. Radiostereometric analysis was used to measure the translation and rotation of the femoral component. The Harris hip score (HHS) was determined to evaluate the clinical outcome. No stem had to be revised. The mean HHS advanced from 35 (SD 11) preoperative to 89 (SD 10) 1 year after surgery. At the end of the observation period, mean subsidence of the stem was 0.26 mm (SD 0.82). Maximum total point motion (MTPM) was 1.23 mm (SD 1.22). The main distal migration took place up to 6 weeks after surgery with nearly no further subsidence up to 2 years postoperatively. All the measured migrations of the hip stem were very small. Results of the HHS demonstrate good clinical outcome. Long-term RSA is necessary to assess possible late migration of the Cerafit standard femoral stem.

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Alendronate Reduces Periprosthetic Bone Loss after Uncemented Primary Total Hip Arthroplasty — A 5-Year Follow-up of 16 Patients

Scandinavian Journal of Surgery ◽

10.1177/145749691009900108 ◽

2010 ◽

Vol 99 (1) ◽

pp. 32-37 ◽

Cited By ~ 26

Author(s):

T. S. Tapaninen ◽

P. K. Venesmaa ◽

J. S. Jurvelin ◽

H. J. A. Miettinen ◽

H.P.J. Kröger

Keyword(s):

Total Hip Arthroplasty ◽

Bone Loss ◽

Hip Arthroplasty ◽

Periprosthetic Bone ◽

Total Hip ◽

Periprosthetic Bone Loss ◽

Primary Total Hip Arthroplasty

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Periprosthetic bone remodelling of two types of uncemented femoral implant with proximal hydroxyapatite coating: a 3-year follow-up study addressing the influence of prosthesis design and preoperative bone density on periprosthetic bone loss

Osteoporosis International ◽

10.1007/s00198-003-1546-5 ◽

2004 ◽

Vol 15 (4) ◽

pp. 281-289 ◽

Cited By ~ 107

Author(s):

A. I. A. Rahmy ◽

T. Gosens ◽

G. M. Blake ◽

A. Tonino ◽

I. Fogelman

Keyword(s):

Bone Density ◽

Bone Loss ◽

Bone Remodelling ◽

Prosthesis Design ◽

Hydroxyapatite Coating ◽

Periprosthetic Bone ◽

Follow Up Study ◽

Periprosthetic Bone Loss

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Continuous periprosthetic bone loss but preserved stability for a collum femoris-preserving stem: follow-up of a prospective cohort study of 21 patients with dualenergy X-ray absorptiometry and radiostereometric analysis with minimum 8 years of follow-up

Acta Orthopaedica ◽

10.2340/17453674.2021.1080 ◽

2022 ◽

pp. 206-211

Author(s):

Andreas Nyström ◽

Demostenis Kiritopoulos ◽

Hans Mallmin ◽

Stergios Lazarinis

Keyword(s):

Bone Loss ◽

Implant Stability ◽

Radiostereometric Analysis ◽

Mineral Density ◽

Periprosthetic Bone ◽

Gruen Zone ◽

X Ray ◽

Periprosthetic Bone Loss

Background and purpose — We previously described a decrease in bone mineral density (BMD) in the calcar region 2 years after insertion of the collum femoris-preserving (CFP) stem, but the implants were stable. Now we have examined the long-term changes in periprosthetic BMD and stability of the CFP stem. Patients and methods — We conducted a minimum 8-year follow-up of 21 patients from our original investigation. We examined periprosthetic BMD by dual-energy X-ray absorptiometry (DEXA) and implant stability by radiostereometric analysis (RSA). Results — Between 2 and 8 years 1 stem was revised due to aseptic loosening. Between 2 and 8 years we found a 14% (95% confidence interval [CI] 9–19) reduction in BMD in Gruen zone 6 and 17% (CI 6–28) in Gruen zone 7. From baseline the reduction in BMD was 30% (CI 23–36) in Gruen zone 6, 39% (CI 31–47) in Gruen zone 7, and 19% (CI 14–23) in Gruen zone 2. Between 2 and 8 years, RSA (n = 17) showed a mean translation along the stem axis of 0.02mm (CI –0.02 to 0.06) and a mean rotation around the stem axis of 0.08° (CI –0.26 to 0.41). From baseline mean subsidence was 0.07 mm (CI –0.16 to 0.03) and mean rotation around the stem axis was 0.23° (CI –0.23 to 0.68) at 8 years. Interpretation — There was continuous loss of proximomedial BMD at 8 years while the CFP stem remained stable. Proximal periprosthetic bone loss cannot be prevented by this stem.

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