Radiological Evaluation of the Relationship Between Cortical Hypertrophy and Stress Shielding After Total Hip Arthroplasty Using a Cementless Stem
Background: Unloading of the proximal medial femoral cortex is usually associated with an increased bone strain at the distal part of the prosthesis, which may cause distal femoral cortical hypertrophy (CH). The objective of this study was to determine the factors that may be considered a predisposi...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2020-12-01
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| Series: | Arthroplasty Today |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352344120301904 |
| _version_ | 1811292898619031552 |
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| author | Makoto Kanto, MD Shigeo Fukunishi, MD Tomokazu Fukui, MD Shoji Nishio, MD Yuki Fujihara, MD Shohei Okahisa, MD Yu Takeda, MD Shinichi Yoshiya, MD Toshiya Tachibana, MD |
| author_facet | Makoto Kanto, MD Shigeo Fukunishi, MD Tomokazu Fukui, MD Shoji Nishio, MD Yuki Fujihara, MD Shohei Okahisa, MD Yu Takeda, MD Shinichi Yoshiya, MD Toshiya Tachibana, MD |
| author_sort | Makoto Kanto, MD |
| collection | DOAJ |
| description | Background: Unloading of the proximal medial femoral cortex is usually associated with an increased bone strain at the distal part of the prosthesis, which may cause distal femoral cortical hypertrophy (CH). The objective of this study was to determine the factors that may be considered a predisposition to distal femoral CH and its effect on the stress shielding (SS) or durability of the fixation of the stem. Methods: A total of 240 total hip arthroplasties were performed between January 2006 and December 2016, with all hips implanted with a Bicontact stem. The minimum follow-up period was more than 2 years, and the mean follow-up period was 7.2 years. The radiographic outcome was assessed on an anteroposterior hip radiograph. CH and SS were assessed on postoperative radiographs in the Gruen zone. We defined CH that appeared in zone 3 or 5 as ‘the focal type’ and defined CH that appeared in zones 2, 3, 4, 5, and 6 as ‘the diffuse type.’ SS followed the procedures from the Engh classification. Results: CH was found in 72 hips (30% of the 240 hips), the focal type was found in 23 hips (9.6% of the 240 hips), and the diffuse type was found in 49 hips (20.4% of the 240 hips). SS was found in 41 hips (17.1% of 240 hips), including 32 hips with SS, which was found after the development of CH. One hip was from the focal-type CH and 31 hips were from the diffuse-type CH. SS, which is typically found in Engh classification types 1 and 2 developed in 13 hips, and SS, which is widely seen in Engh classification types 3 and 4 developed in 19 hips. All 19 hips with progressed SS were found after the diffuse-type CH had developed. In addition, among the 19 hips with progressed SS, Dorr type A was found in 0 hips, Dorr type B in 8 hips, and Dorr type C in 11 hips. Conclusions: According to the results of our radiological evaluation, development of the diffuse-type CH after total hip arthroplasty using Bicontact stems is one of the critical causes of the later development of SS and could be predicted to progress to SS. To prevent the development of the diffuse-type CH, the indication to choose a Bicontact stem for a Dorr type C with osteoporotic bone should be considered. |
| first_indexed | 2024-04-13T04:52:28Z |
| format | Article |
| id | doaj.art-57d99c5fdfb7494aae62376042c73b7d |
| institution | Directory Open Access Journal |
| issn | 2352-3441 |
| language | English |
| last_indexed | 2024-04-13T04:52:28Z |
| publishDate | 2020-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Arthroplasty Today |
| spelling | doaj.art-57d99c5fdfb7494aae62376042c73b7d2022-12-22T03:01:37ZengElsevierArthroplasty Today2352-34412020-12-0164894900Radiological Evaluation of the Relationship Between Cortical Hypertrophy and Stress Shielding After Total Hip Arthroplasty Using a Cementless StemMakoto Kanto, MD0Shigeo Fukunishi, MD1Tomokazu Fukui, MD2Shoji Nishio, MD3Yuki Fujihara, MD4Shohei Okahisa, MD5Yu Takeda, MD6Shinichi Yoshiya, MD7Toshiya Tachibana, MD8Department of Orthopedic Surgery, Hyogo College of Medicine, Nishinomiya City, Hyogo, Japan; Corresponding author. Department of Orthopedic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya City, Hyogo, Japan 653-8501. Tel.: +81 798 45 6111.Nishinomiya Kaisei Hospital, Nishinomiya City, Hyogo, JapanDepartment of Orthopedic Surgery, Hyogo College of Medicine, Nishinomiya City, Hyogo, JapanDepartment of Orthopedic Surgery, Hyogo College of Medicine, Nishinomiya City, Hyogo, JapanDepartment of Orthopedic Surgery, Hyogo College of Medicine, Nishinomiya City, Hyogo, JapanDepartment of Orthopedic Surgery, Hyogo College of Medicine, Nishinomiya City, Hyogo, JapanNishinomiya Kaisei Hospital, Nishinomiya City, Hyogo, JapanNishinomiya Kaisei Hospital, Nishinomiya City, Hyogo, JapanDepartment of Orthopedic Surgery, Hyogo College of Medicine, Nishinomiya City, Hyogo, JapanBackground: Unloading of the proximal medial femoral cortex is usually associated with an increased bone strain at the distal part of the prosthesis, which may cause distal femoral cortical hypertrophy (CH). The objective of this study was to determine the factors that may be considered a predisposition to distal femoral CH and its effect on the stress shielding (SS) or durability of the fixation of the stem. Methods: A total of 240 total hip arthroplasties were performed between January 2006 and December 2016, with all hips implanted with a Bicontact stem. The minimum follow-up period was more than 2 years, and the mean follow-up period was 7.2 years. The radiographic outcome was assessed on an anteroposterior hip radiograph. CH and SS were assessed on postoperative radiographs in the Gruen zone. We defined CH that appeared in zone 3 or 5 as ‘the focal type’ and defined CH that appeared in zones 2, 3, 4, 5, and 6 as ‘the diffuse type.’ SS followed the procedures from the Engh classification. Results: CH was found in 72 hips (30% of the 240 hips), the focal type was found in 23 hips (9.6% of the 240 hips), and the diffuse type was found in 49 hips (20.4% of the 240 hips). SS was found in 41 hips (17.1% of 240 hips), including 32 hips with SS, which was found after the development of CH. One hip was from the focal-type CH and 31 hips were from the diffuse-type CH. SS, which is typically found in Engh classification types 1 and 2 developed in 13 hips, and SS, which is widely seen in Engh classification types 3 and 4 developed in 19 hips. All 19 hips with progressed SS were found after the diffuse-type CH had developed. In addition, among the 19 hips with progressed SS, Dorr type A was found in 0 hips, Dorr type B in 8 hips, and Dorr type C in 11 hips. Conclusions: According to the results of our radiological evaluation, development of the diffuse-type CH after total hip arthroplasty using Bicontact stems is one of the critical causes of the later development of SS and could be predicted to progress to SS. To prevent the development of the diffuse-type CH, the indication to choose a Bicontact stem for a Dorr type C with osteoporotic bone should be considered.http://www.sciencedirect.com/science/article/pii/S2352344120301904Total hip arthroplastyStress shieldingCortical hypertrophy |
| spellingShingle | Makoto Kanto, MD Shigeo Fukunishi, MD Tomokazu Fukui, MD Shoji Nishio, MD Yuki Fujihara, MD Shohei Okahisa, MD Yu Takeda, MD Shinichi Yoshiya, MD Toshiya Tachibana, MD Radiological Evaluation of the Relationship Between Cortical Hypertrophy and Stress Shielding After Total Hip Arthroplasty Using a Cementless Stem Arthroplasty Today Total hip arthroplasty Stress shielding Cortical hypertrophy |
| title | Radiological Evaluation of the Relationship Between Cortical Hypertrophy and Stress Shielding After Total Hip Arthroplasty Using a Cementless Stem |
| title_full | Radiological Evaluation of the Relationship Between Cortical Hypertrophy and Stress Shielding After Total Hip Arthroplasty Using a Cementless Stem |
| title_fullStr | Radiological Evaluation of the Relationship Between Cortical Hypertrophy and Stress Shielding After Total Hip Arthroplasty Using a Cementless Stem |
| title_full_unstemmed | Radiological Evaluation of the Relationship Between Cortical Hypertrophy and Stress Shielding After Total Hip Arthroplasty Using a Cementless Stem |
| title_short | Radiological Evaluation of the Relationship Between Cortical Hypertrophy and Stress Shielding After Total Hip Arthroplasty Using a Cementless Stem |
| title_sort | radiological evaluation of the relationship between cortical hypertrophy and stress shielding after total hip arthroplasty using a cementless stem |
| topic | Total hip arthroplasty Stress shielding Cortical hypertrophy |
| url | http://www.sciencedirect.com/science/article/pii/S2352344120301904 |
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