Peri-acetabular bone remodelling after uncemented total hip arthroplasty with monoblock press-fit cups: an observational
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(2020) 21:652
RESEARCH ARTICLE
Open Access
Peri-acetabular bone remodelling after uncemented total hip arthroplasty with monoblock press-fit cups: an observational study Conrad Anderl1* , Georg Mattiassich1,2, Reinhold Ortmaier1,3, Martin Steinmair1 and Josef Hochreiter1
Abstract Background: Bone stock preservation in total hip replacement is essential to allow for later revisions in an increasingly younger and fitter index patient population. While contemporary modular press-fit acetabular cups lead to rigid fixation with equatorial stress and central osteolysis, more elastic fixation may cause different peri-acetabular bone remodelling. The purpose of this study was to investigate changes in peri-acetabular bone mineral density (BMD) in uncemented elastic fixation with monoblock press-fit cups. Methods: This prospective observational study included 45 patients with monoblock cups. We evaluated periacetabular BMD using dual-energy X-ray absorptiometry and reported functional outcomes and complications. Results: At a mean follow-up of 24.2 ± 2.2 months, we found that BMD stabilised in DeLee and Charnley zones I and III and recovered to baseline value in zone II. The mean Harris Hip Scores improved significantly from 56.9 ± 20.0 to 97.2 ± 4.0 (p < 0001). Other than one peri-operative dislocation, we saw no post-operative complications. Conclusions: We found favourable adaptive bone changes with BMD stabilisation in the equatorial zones and recovery to pre-operative values in the central zone. Additionally, excellent clinical outcomes and few prosthesisrelated complications strengthened the favourable results of monoblock acetabular cups. Trial registration: Registration number DRKS00017076. Keywords: Total hip arthroplasty, Monoblock cups, Bone remodelling, Elastic fixation, Bone mineral density, DEXA
Background Initially, total hip arthroplasty (THA) was primarily used in low-demand elderly patients. As prosthetic design developed, however, indications for THA expanded to include younger and more active patients with higher demands [1]. Because younger patients were more at risk * Correspondence: [email protected] 1 Department of Orthopaedic Surgery, Ordensklinikum Barmherzige Schwestern, Vinzenz Gruppe, Center of Orthopaedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, Seilerstätte 4, 4020 Linz, Austria Full list of author information is available at the end of the article
to undergo revision surgeries in the future [2], treating bone stock and soft tissue with care at the index procedure became increasingly more important to allow future revisions [3]. Revision of the acetabular component is a limiting factor in the longevity of hip replacement with wear and aseptic loosening being leading causes of failure [4–6]. Primary fixation of the cup is therefore extremely important to achieve long-lasting results. Two types of biomechanical fixation concepts may be employed in acetabular fixation of uncemented THA depending on cup design: rigid or elastic fixation.
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