scholarly journals Predicting Bone Remodeling in Response to Orthopedic Implantations: Computational Study Using a Mechano-Biochemical Model

2021 ◽  
Author(s):  
Pouria Tavakkoli Avval
Keyword(s):  
Bone Density ◽  
Bone Loss ◽  
Bone Remodeling ◽  
Bone Fracture ◽  
Mineral Density ◽  
Periprosthetic Bone ◽  
Premature Failure ◽  
Gruen Zone ◽  
Periprosthetic Bone Loss

Periprosthetic bone loss following orthopedic implantations is a serious concern leading to the premature failure of the implants. Therefore, investigating bone remodeling in response to orthopedic implantations is of paramount importance for the purpose of designing long lasting prostheses. In this study, a predictive bone remodeling model (Thermodynamic-based model) was employed to simulate the long-term response of femoral density to total hip arthroplasty (THA), bone fracture plating and intramedullary (IM) nailing. The ability of the model in considering the coupling effect between mechanical loading and bone biochemistry is its unique characteristic. This research provided quantitative data for monitoring bone density changes throughout the femoral bone. The results obtained by the thermodynamic-based model agreed well with the bone morphology and the literature. The study revealed that the most significant periprosthetic bone loss in response to THA occurred in calcar region (Gruen zone 7). Conversely, the region beneath the hip stem (Gruen zone 4) experienced the lowest bone mineral density (BMD) changes. It was found that the composite hip implant and IM nail were more advantageous over the metallic ones as they induced less stress shielding and provided more uniform bone density changes following the surgery. The research study also showed that, due to plating, the areas beneath the bone fracture plate experienced severe bone loss. However, some level of bone formation was observed at the vicinity of the most proximal and distal screw holes in both lateral and anterior plated femurs. Furthermore, in terms of long-term density distributions, the anterior plating was not superior to the lateral plating.

scholarly journals Predicting Bone Remodeling in Response to Orthopedic Implantations: Computational Study Using a Mechano-Biochemical Model

2021 ◽  
Author(s):  
Pouria Tavakkoli Avval
Keyword(s):  
Bone Density ◽  
Bone Loss ◽  
Bone Remodeling ◽  
Bone Fracture ◽  
Mineral Density ◽  
Periprosthetic Bone ◽  
Premature Failure ◽  
Gruen Zone ◽  
Periprosthetic Bone Loss

Periprosthetic bone loss following orthopedic implantations is a serious concern leading to the premature failure of the implants. Therefore, investigating bone remodeling in response to orthopedic implantations is of paramount importance for the purpose of designing long lasting prostheses. In this study, a predictive bone remodeling model (Thermodynamic-based model) was employed to simulate the long-term response of femoral density to total hip arthroplasty (THA), bone fracture plating and intramedullary (IM) nailing. The ability of the model in considering the coupling effect between mechanical loading and bone biochemistry is its unique characteristic. This research provided quantitative data for monitoring bone density changes throughout the femoral bone. The results obtained by the thermodynamic-based model agreed well with the bone morphology and the literature. The study revealed that the most significant periprosthetic bone loss in response to THA occurred in calcar region (Gruen zone 7). Conversely, the region beneath the hip stem (Gruen zone 4) experienced the lowest bone mineral density (BMD) changes. It was found that the composite hip implant and IM nail were more advantageous over the metallic ones as they induced less stress shielding and provided more uniform bone density changes following the surgery. The research study also showed that, due to plating, the areas beneath the bone fracture plate experienced severe bone loss. However, some level of bone formation was observed at the vicinity of the most proximal and distal screw holes in both lateral and anterior plated femurs. Furthermore, in terms of long-term density distributions, the anterior plating was not superior to the lateral plating.

Predicting Bone Remodeling in Response to Total Hip Arthroplasty: Computational Study Using Mechanobiochemical Model

2014 ◽  
Vol 136 (5) ◽  
Author(s):  
Pouria Tavakkoli Avval ◽  
Václav Klika ◽  
Habiba Bougherara
Keyword(s):  
Bone Density ◽  
Total Hip Arthroplasty ◽  
Bone Loss ◽  
Bone Remodeling ◽  
Hip Arthroplasty ◽  
Periprosthetic Bone ◽  
Premature Failure ◽  
Gruen Zone ◽  
Total Hip ◽  
Periprosthetic Bone Loss

Periprosthetic bone loss following total hip arthroplasty (THA) is a serious concern leading to the premature failure of prosthetic implant. Therefore, investigating bone remodeling in response to hip arthroplasty is of paramount for the purpose of designing long lasting prostheses. In this study, a thermodynamic-based theory, which considers the coupling between the mechanical loading and biochemical affinity as stimulus for bone formation and resorption, was used to simulate the femoral density change in response to THA. The results of the numerical simulations using 3D finite element analysis revealed that in Gruen zone 7, after remarkable postoperative bone loss, the bone density started recovering and got stabilized after 9% increase. The most significant periprosthetic bone loss was found in Gruen zone 7 (−17.93%) followed by zone 1 (−13.77%). Conversely, in zone 4, bone densification was observed (+4.63%). The results have also shown that the bone density loss in the posterior region of the proximal metaphysis was greater than that in the anterior side. This study provided a quantitative figure for monitoring the distribution variation of density throughout the femoral bone. The predicted bone density distribution before and after THA agree well with the bone morphology and previous results from the literature.

scholarly journals 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

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.

scholarly journals Perioperative Patient-specific Factors-based Nomograms Predict Short-term Periprosthetic Bone Loss After Total Hip Arthroplasty

2020 ◽  
Author(s):  
Guangtao Fu ◽  
Mengyuan Li ◽  
Yunlian Xue ◽  
Qingtian Li ◽  
Zhantao Deng ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Bone Loss ◽  
Hip Arthroplasty ◽  
Postoperative Period ◽  
Patient Specific ◽  
Mineral Density ◽  
Periprosthetic Bone ◽  
Gruen Zone ◽  
Total Hip ◽  
Periprosthetic Bone Loss

Abstract Background Although medical intervention of periprosthetic bone loss in the immediate postoperative period was recommended, not all the patients experienced periprosthetic bone loss after total hip arthroplasty (THA). Prediction toolsthat enrolledallpotential risk factors to calculate an individualized prediction of postoperative periprosthetic bone loss were strongly needed for clinical decision-making.MethodsData of the patients underwent primary unilateral cementless THA between April 2015 and October 2017 in our center were retrospectively collected. Candidate variables included demographic data and bone mineral density (BMD) in spine, hip and periprosthetic regions that measured 1 week after THA. Outcomes of interest included the risk of postoperative periprosthetic bone loss in Gruen zone 1, 7 and total zones in the 1st postoperative year. Nomograms were presented based on multiple logistic regressions via R language.Bootstrap was used for internal validation. Results 427 patients (195 male and 232 female) were included in this study.The mean BMD of Gruen zone 1, 7,and total were decreased by 4.1%, 6.4%, and 1.7% at the 1st year after THA, respectively. 61.1% of the patients (261/427) experienced bone loss in Gruen zone 1 at the 1st postoperative year, while there were 58.1% (248/427) in Gruen zone 7 and 63.0% (269/427) in Gruen zone total. Bias-corrected c-index for risk of postoperative bone lossin Gruen zone 1, 7 and total zones in the 1st postoperative year were 0.700, 0.785, and 0.696, respectively. The most highly influential factor for the postoperative periprosthetic bone loss was the BMD in the corresponding Gruen zones at the baseline.ConclusionsThe present study presented the perioperative factors-based nomograms for predicting periprosthetic bone loss after THA with adequate predictive discrimination and calibration.Those tools would helpsurgeons to identify high-risk patients who may benefit from anti-bone-resorptive treatment on the early postoperative period effectively. Such prediction model could also provide patients with reasonable expectations following surgery, which may improve satisfaction and patient compliance.

scholarly journals Perioperative patient-specific factors-based nomograms predict short-term periprosthetic bone loss after total hip arthroplasty

2020 ◽  
Author(s):  
Guangtao Fu ◽  
Mengyuan Li ◽  
Yunlian Xue ◽  
Qingtian Li ◽  
Zhantao Deng ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Bone Loss ◽  
Hip Arthroplasty ◽  
Postoperative Period ◽  
Patient Specific ◽  
Mineral Density ◽  
Periprosthetic Bone ◽  
Gruen Zone ◽  
Total Hip ◽  
Periprosthetic Bone Loss

Abstract Background: Although medical intervention of periprosthetic bone loss in the immediate postoperative period was recommended, not all the patients experienced periprosthetic bone loss after total hip arthroplasty (THA). Prediction tools that enrolled all potential risk factors to calculate an individualized prediction of postoperative periprosthetic bone loss were strongly needed for clinical decision-making. Methods: Data of the patients underwent primary unilateral cementless THA between April 2015 and October 2017 in our center were retrospectively collected. Candidate variables included demographic data and bone mineral density (BMD) in spine, hip and periprosthetic regions that measured 1 week after THA. Outcomes of interest included the risk of postoperative periprosthetic bone loss in Gruen zone 1, 7 and total zones in the 1st postoperative year. Nomograms were presented based on multiple logistic regressions via R language. 1000 Bootstraps were used for internal validation. Results: 563 patients met the inclusion criteria were enrolled, and the final analysis was performed in 427 patients (195 male and 232 female) after the exclusion. The mean BMD of Gruen zone 1, 7, and total were decreased by 4.1%, 6.4%, and 1.7% at the 1st year after THA, respectively. 61.1% of the patients (261/427) experienced bone loss in Gruen zone 1 at the 1st postoperative year, while there were 58.1% (248/427) in Gruen zone 7 and 63.0% (269/427) in Gruen zone total. Bias-corrected c-index for risk of postoperative bone loss in Gruen zone 1, 7 and total zones in the 1st postoperative year were 0.700, 0.785, and 0.696, respectively. The most highly influential factors for the postoperative periprosthetic bone loss were primary diagnosis and BMD in the corresponding Gruen zones at the baseline. Conclusions: To the best of our knowledge, our study represented the first time to use the nomograms in estimating the risk of postoperative periprosthetic bone loss with adequate predictive discrimination and calibration. Those predictive models would help surgeons to identify high-risk patients who may benefit from anti-bone-resorptive treatment on the early postoperative period effectively. It is also beneficial for patients, as they can choose the treatment options based on a reasonable expectation following surgery.

scholarly journals Perioperative patient-specific factors-based nomograms predict short-term periprosthetic bone loss after total hip arthroplasty

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Guangtao Fu ◽  
Mengyuan Li ◽  
Yunlian Xue ◽  
Qingtian Li ◽  
Zhantao Deng ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Bone Loss ◽  
Hip Arthroplasty ◽  
Postoperative Period ◽  
Patient Specific ◽  
Mineral Density ◽  
Periprosthetic Bone ◽  
Gruen Zone ◽  
Total Hip ◽  
Periprosthetic Bone Loss

Abstract Background Although medical intervention of periprosthetic bone loss in the immediate postoperative period was recommended, not all the patients experienced periprosthetic bone loss after total hip arthroplasty (THA). Prediction tools that enrolled all potential risk factors to calculate an individualized prediction of postoperative periprosthetic bone loss were strongly needed for clinical decision-making. Methods Data of the patients who underwent primary unilateral cementless THA between April 2015 and October 2017 in our center were retrospectively collected. Candidate variables included demographic data and bone mineral density (BMD) in spine, hip, and periprosthetic regions that measured 1 week after THA. Outcomes of interest included the risk of postoperative periprosthetic bone loss in Gruen zone 1, 7, and total zones in the 1st postoperative year. Nomograms were presented based on multiple logistic regressions via R language. One thousand Bootstraps were used for internal validation. Results Five hundred sixty-three patients met the inclusion criteria were enrolled, and the final analysis was performed in 427 patients (195 male and 232 female) after the exclusion. The mean BMD of Gruen zone 1, 7, and total were decreased by 4.1%, 6.4%, and 1.7% at the 1st year after THA, respectively. 61.1% of the patients (261/427) experienced bone loss in Gruen zone 1 at the 1st postoperative year, while there were 58.1% (248/427) in Gruen zone 7 and 63.0% (269/427) in Gruen zone total. Bias-corrected C-index for risk of postoperative bone loss in Gruen zone 1, 7, and total zones in the 1st postoperative year were 0.700, 0.785, and 0.696, respectively. The most highly influential factors for the postoperative periprosthetic bone loss were primary diagnosis and BMD in the corresponding Gruen zones at the baseline. Conclusions To the best of our knowledge, our study represented the first time to use the nomograms in estimating the risk of postoperative periprosthetic bone loss with adequate predictive discrimination and calibration. Those predictive models would help surgeons to identify high-risk patients who may benefit from anti-bone-resorptive treatment in the early postoperative period effectively. It is also beneficial for patients, as they can choose the treatment options based on a reasonable expectation following surgery.

scholarly journals Long-term bone remodelling around ‘legendary’ cementless femoral stems

2018 ◽  
Vol 3 (2) ◽  
pp. 45-57 ◽  
Author(s):  
Charles Rivière ◽  
Guido Grappiolo ◽  
Charles A. Engh ◽  
Jean-Pierre Vidalain ◽  
Antonia-F. Chen ◽  
...  
Keyword(s):  
Bone Loss ◽  
Bone Remodelling ◽  
Bone Ingrowth ◽  
Stress Shielding ◽  
Implant Design ◽  
Periprosthetic Bone ◽  
Femoral Stems ◽  
Periprosthetic Bone Loss ◽  
Load Pattern

Bone remodelling around a stem is an unavoidable long-term physiological process highly related to implant design. For some predisposed patients, it can lead to periprosthetic bone loss secondary to severe stress-shielding, which is thought to be detrimental by contributing to late loosening, late periprosthetic fracture, and thus rendering revision surgery more complicated. However, these concerns remain theoretical, since late loosening has yet to be documented among bone ingrowth cementless stems demonstrating periprosthetic bone loss associated with stress-shielding. Because none of the stems replicate the physiological load pattern on the proximal femur, each stem design is associated with a specific load pattern leading to specific adaptive periprosthetic bone remodelling. In their daily practice, orthopaedic surgeons need to differentiate physiological long-term bone remodelling patterns from pathological conditions such as loosening, sepsis or osteolysis. To aid in that process, we decided to clarify the behaviour of the five most used femoral stems. In order to provide translational knowledge, we decided to gather the designers’ and experts’ knowledge and experience related to the design rationale and the long-term bone remodelling of the following femoral stems we deemed ‘legendary’ and still commonly used: Corail (Depuy); Taperloc (Biomet); AML (Depuy); Alloclassic (Zimmer); and CLS-Spotorno (Zimmer).Cite this article: EFORT Open Rev 2018;3:45-57. DOI: 10.1302/2058-5241.3.170024

scholarly journals Influence of alendronate therapy on the results of densitometric examination after implantation of total hip endoprosthesis

2021 ◽  
Vol 13 (1) ◽  
pp. 32-38
Author(s):  
Ilir Shabani ◽  
Antonio Gavrilovski ◽  
Vilijam Velkovski ◽  
Nenad Atanasov ◽  
Shaban Memeti ◽  
...  
Keyword(s):  
Bone Resorption ◽  
Bone Loss ◽  
Bone Mass ◽  
Bone Mineral ◽  
Mineral Content ◽  
Mineral Density ◽  
Periprosthetic Bone ◽  
Hip Endoprosthesis ◽  
Periprosthetic Bone Loss ◽  
Post Implantation

The development of aloarthroplasty of the hip is continuously rising. After implantation of a total cement-free hip endoprosthesis, often there is a periprosthetic femoral bone loss. Alendronate has been shown to be a potent inhibitor of bone resorption activity; it inhibits osteoclastic bone resorption, increases bone mass, and plays a significant role in post-implantation stabilization of the femur. The aim of this study was to determine the effect of alendronate on osteointegration of hip endoprosthesis.Material and methods: The study analyzed 10 patients operated on with implantation of a total cement-free hip endoprosthesis (THP). The included patients were examined by a radiographic method at 6 and 12 months and DXA method at 6 and 12 months. Results: The study showed differences in the values of bone mineral density and bone mineral content in the interval between 6 and 12 months in patients undergoing THP, and hence we can conclude that alendronate therapy after THP implantation reduced periprosthetic loss of bone mass and implant stiffening. Alendronate is a proven inhibitor of periprosthetic bone loss that occurs after prirmary impantation of a total cement-free hip endoprosthesis.

Prophylactic efficacy on periprosthetic bone loss in calcar region after total hip arthroplasty of antiosteoporotic drugs: a network meta-analysis of randomised controlled studies

2020 ◽  
pp. postgradmedj-2019-137120
Author(s):  
Xi Chen ◽  
Yu Shen ◽  
Chenyi Ye ◽  
Yishake Mumingjiang ◽  
Jinwei Lu ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Bone Loss ◽  
Hip Arthroplasty ◽  
Meta Analysis ◽  
Residual Effect ◽  
Periprosthetic Bone ◽  
Prophylactic Efficacy ◽  
Total Hip ◽  
Periprosthetic Bone Loss

ObjectivesThe aim of this study was to evaluate the effect of antiosteoporotic drugs on preventing periprosthetic bone loss in calcar 6 and 12 months after total hip arthroplasty.MethodsThe network meta-analysis was conducted guided by the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guideline. A systematic literature search was conducted and 21 studies that enrolled a total of 955 patients with 9 antiosteoporotic drugs met the inclusion criteria. Network meta-analysis and conventional meta-analysis were carried out for calculating standard mean difference (SMD) and the surface under cumulative ranking curve (SUCRA) of the bone mineral density (BMD) in calcar (Gruen zone 7) as well as bone turnover markers (BTMs) including bone-specific alkaline phosphatase (BSAP) and collagen type I cross-linked N telopeptide (NTX) at 6 and 12 months between different antiosteoporotic drugs.ResultsAt 6 months after total hip arthroplasty, zoledronate (SUCRA=86.4%), risedronate (SUCRA=51.3%) and etidronate (SUCRA=44.5%) were effective in retaining BMD in calcar; zoledronate was significantly more effective than etidronate (SMD=0.65, 95% CI 0.03 to 1.27). Teriparatide (SUCRA=84.5%), denosumab (SUCRA=82.5%), zoledronate (SUCRA=69.2%), alendronate+alfacalcidol (SUCRA=66.2%) and etidronate (SUCRA=51.5%) were the top five drugs in retaining BMD in calcar at 12 months after total hip arthroplasty and the efficacy were comparable. After simultaneously excluding studies in which the prosthesis were cement and the drug dosages as well as treatment durations were inconsistent with those in treating osteoporosis, the above results were robust with the exception that alendronate showed significant efficacy compared with placebo (SMD=1.22, 95% CI 0.46 to 1.99) and was comparable with those effective drugs at 12 months. Long-term residual effect was corroborated only in etidronate, alendronate and zoledronate from previous studies. BTMs were significantly decreased as early as 6 months (SMD of BSAP −0.49, 95% CI −0.84 to −0.13; SMD of NTX −0.93, 95% CI −1.21 to −0.64) and sustained until 12 months (SMD of BSAP −0.27, 95% CI −0.50 to −0.03; SMD of NTX −0.84, 95% CI −1.11 to −0.56) during the prophylaxis.ConclusionsAntiosteoporotic drugs showed prophylactic efficacy on periprosthetic bone loss after total hip arthroplasty in calcar, the effectiveness varied. Zoledronate was the best recommendation due to its optimal efficacy both within 6 and 12 months as well as its residual effect in the long term. BTMs could be used as indicators for monitoring through the treatment. More head-to-head clinical trials are needed to confirm those findings.

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