Slullitel, P.A., Mahatma, M.M., Farzi, M. et al. (3 more authors) (2021) Influence of femoral component design on proximal femoral bone mass after total hip replacement : a randomized controlled trial. Journal of Bone and Joint Surgery, 103 (1). pp. 74-83. ISSN 0021-9355
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.
Metadata
Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2020 by The Journal of Bone and Joint Surgery. This is an author-produced version of a paper subsequently published in JBJS. Uploaded in accordance with the publisher's self-archiving policy. | ||||
Dates: |
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Institution: | The University of Sheffield | ||||
Academic Units: | The University of Sheffield > Sheffield Teaching Hospitals | ||||
Funding Information: |
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Depositing User: | Symplectic Sheffield | ||||
Date Deposited: | 30 Oct 2020 10:58 | ||||
Last Modified: | 09 Feb 2022 11:13 | ||||
Status: | Published | ||||
Publisher: | Wolters Kluwer Health | ||||
Refereed: | Yes | ||||
Identification Number: | https://doi.org/10.2106/jbjs.20.00351 | ||||
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