Abstract
Background: Joint replacements are being performed on ever younger patients at a time when average expectancy of life is continuing to rise. Any reduction in the strength and mass of periprosthetic bone could threaten the longevity of implant by predisposing to loosening and migration of prosthesis, periprosthetic fracture and problems in revision arthroplasty.
Aims & Objectives: This study aims to analyse the femoral periprosthetic stress-shielding following unilateral cementless total hip replacement using DEXA scan by quantifying the changes in bone mineral density around femoral component over a period of one year and identify the factors influencing the bone loss.
Material & Method: Femoral periprosthetic bone mineral density was measured in the seven Gruen Zones with DEXA scan at 2 weeks, 3 months and 1 year after surgery in 20 patients who had undergone unilateral cementless total hip replacement, of which 10 patients had been implanted with 4/5th porous coated CoCr stems and other 10 patients with 1/3rd porous coated titanium alloy stems.
Results: At both 3 months and one year postoperatively, bone loss due to stress-shielding was seen in both stems with maximum loss in zone VII and minimum in zone III, IV, V. The maximum mean percentage bone mineral density loss in 4/5th porous coated CoCr stems in zone VII was 16.03% at 3 month and 22.42% at 1 year as compared to loss of 10.07% and 16.01% in 1/3rd porous coated Ti alloy stems. Increased bone loss was seen in patients who had larger diameter stem (> 13.0 mm) and in patients with low bone mineral density in the unoperated hip.
Conclusion: Bone loss as a result of stress-shielding is more pronounced in 4/5th porous coated CoCr stems as compared to 1/3rd porous coated titanium alloy stems.
Correspondence should be addressed to Mr John Hodgkinson, BHS, c/o BOA, The Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE.
