Implantation of a cementless press-fit acetabular cup during hip arthroplasty alters stress transfer to the periacetabular bone, resulting in stress shielding of cancellous bone and enhanced load transfer to cortical bone. Theoretically, the thicker, stiffer and larger acetabular cup of a hip resurfacing may increase periacetabular bone stress shielding.
We attempted to assess the matter (at a minimum of 2 years after surgery) by measuring any difference in supra acetabular bone mineral density (BMD) between the side implanted with a thick monoblock cobalt-chromium (Co-Cr) acetabular component during hip resurfacing (HR) and the opposite non-operated side.
We retrospectively recruited 44 patients who had undergone metal-on-metal hybrid hip resurfacing for unilateral osteoarthritis of the hip joint. BMD of the supra acetabular bone of both hips was measured using a dual energy X-ray absorptiometry (DEXA) scan.
The BMD measured in Zone 2 was not different on the operated side (1.69 g/cm2 ± 0.48) compared with the non-operated side (1.70 g/cm2 ±0.49) (p=0.904).
Contrary to our expectations, implantation of a monoblock Co-Cr acetabular component during HR did not cause significant stress-shielding of supra acetabular cancellous bone.
HuiskesR.. Finite element analysis of acetabular reconstruction. Noncemented threaded cups.Acta Orthop Scand1987; 58: 620–5.
2.
LevenstonM.E., BeaupreG.S., SchurmanD.J., CarterD.R.. Computer simulations of stress-related bone remodeling around noncemented acetabular components.J Arthroplasty1993; 8: 595–605.
3.
MuellerL.A., KressA., NowakT.. Periacetabular bone changes after uncemented total hip arthroplasty evaluated by quantitative computed tomography.Acta Orthop2006; 77: 380–5.
4.
FieldR.E., CroninM.D., SinghP.J., BurtenshawC., RushtonN.. Bone remodeling around the Cambridge cup: a DEXA study of 50 hips over 2 years.Acta Orthop2006; 77: 726–32.
5.
MeneghiniR.M., FordK.S., McColloughC.H., HanssenA.D., LewallenD.G.. Bone remodeling around porous metal cementless acetabular components.J Arthroplasty2009; 25: 741–7.
6.
ShettyN.R., HamerA.J., KerryR.M., StockleyI., EastellR., WilkinsonJ.M.. Bone remodelling around a cemented polyethylene cup. A longitudinal densitometry study.J Bone Joint Surg Br2006; 88: 455–9.
7.
DigasG., KarrholmJ., ThannerJ.. Addition of fluoride to acrylic bone cement does not improve fixation of a total hip arthroplasty stem.Clin Orthop Relat Res2006; 448: 58–66.
8.
WrightJ.M., PellicciP.M., SalvatiE.A., GhelmanB., RobertsM.M., KohJ.L.. Bone density adjacent to press-fit acetabular components. A prospective analysis with quantitative computed tomography.J Bone Joint Surg Am2001; 83: 529–36.
9.
BrennanS.A., HartyJ.A., GormleyC, O'RourkeS.K.. Comparison of acetabular reamings during hip resurfacing versus uncemented total hip arthroplasty.J Orthop Surg (Hong Kong)2009; 17: 42–6.
10.
LougheadJ.M., StarksI., ChesneyD., MatthewsJ.N., McCaskieA.W., HollandJ.P.. Removal of acetabular bone in resurfacing arthroplasty of the hip: a comparison with hybrid total hip arthroplasty.J Bone Joint Surg Br2006; 88: 31–4.
11.
VendittoliP.A., LavigneM., GirardJ., RoyA.G.. A randomised study comparing resection of acetabular bone at resurfacing and total hip replacement.J Bone Joint Surg Br2006; 88: 997–1002.
BellamyN., BuchananW.W., GoldsmithC.H., CampbellJ., StittL.W.. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee.J Rheumatol1988; 15: 1833–40.
14.
AmstutzH.C., ThomasB.J., JinnahR., KimW., GroganT., YaleC.. Treatment of primary osteoarthritis of the hip. A comparison of total joint and surface replacement arthroplasty.J Bone Joint Surg Am1984; 66: 228–41.
15.
GirardJ., LavigneM., VendittoliP.A., RoyA.G.. Biomechanical reconstruction of the hip: a randomised study comparing total hip resurfacing and total hip arthroplasty.J Bone Joint Surg Br2006; 88: 721–6.
16.
WilkinsonJ.M., PeelN.F., ElsonR.A., StockleyI., EastellR.. Measuring bone mineral density of the pelvis and proximal femur after total hip arthroplasty.J Bone Joint Surg Br2001; 83: 283–8.
17.
LandisJ.R., KochG.G.. The measurement of observer agreement for categorical data.Biometrics1977; 33: 159–74.
18.
KimY.H., YoonS.H., KimJ.S.. Changes in the bone mineral density in the acetabulum and proximal femur after cementless total hip replacement: alumina-on-alumina versus alumina-on-polyethylene articulation.J Bone Joint Surg Br2007; 89: 174–9.
19.
KorovessisP., PiperosG., MichaelA.. Periprosthetic bone mineral density after Mueller and Zweymueller total hip arthroplasties.Clin Orthop Relat Res1994; 309: 214–21.
20.
SaboD., ReiterA., SimankH.G., ThomsenM., LukoschekM., EwerbeckV.. Periprosthetic mineralization around cementless total hip endoprosthesis: longitudinal study and cross-sectional study on titanium threaded acetabular cup and cementless Spotorno stem with DEXA.Calcif Tissue Int1998; 62: 177–82.
21.
KorovessisP., DroutsasP., PiperosG., MichaelA., BaikousisA., StamatakisM.. Course of bone mineral content changes around cementless Zweymueller total hip arthroplasty. A 4-year follow-up study.Arch Orthop Trauma Surg1997; 116: 60–5.
22.
PoggieR.A., BrownT.D., PedersenD.R.. Finite element analysis of peri-acetabular stress of cemented, metal-backed, and porous tantalum backed acetabular component. ed. O.R.S. 45th Annual Meeting, February 1–4, 1999, Anaheim, California.
23.
SchmidtR., MullerL., KressA., HirschfelderH., AplasA., PittoR.P.. A computed tomography assessment of femoral and acetabular bone changes after total hip arthroplasty.Int Orthop2002; 26: 299–302.
24.
KishidaY., SuganoN., NishiiT., MikiH., YamaguchiK., YoshikawaH.. Preservation of the bone mineral density of the femur after surface replacement of the hip.J Bone Joint Surg Br2004; 86: 185–9.
25.
LianY.Y., PeiF.X., YooM.C., ChengJ.Q., FatouC.Y.. Changes of the bone mineral density in proximal femur following total hip resurfacing arthroplasty in osteonecrosis of femoral head.J Orthop Res2008; 26: 453–9.
MuellerL.A., SchmidtR., EhrmannC.. Modes of periacetabular load transfer to cortical and cancellous bone after cemented versus uncemented total hip arthroplasty: a prospective study using computed tomography-assisted osteodensitometry.J Orthop Res2009; 27: 176–82.
28.
MuellerL.A., VoelkM., KressA., PittoR.P., SchmidtR.. An ABJS Best Paper: Progressive cancellous and cortical bone remodeling after press-fit cup fixation: a 3-year followup.Clin Orthop Relat Res2007; 463: 213–20.
29.
DigasG., KarrholmJ., ThannerJ.Different loss of BMD using uncemented press-fit and whole polyethylene cups fixed with cement: repeated DXA studies in 96 hips randomized to 3 types of fixation.Acta Orthop2006; 77: 218–26.
30.
DeLeeJ.G., CharnleyJ.. Radiological demarcation of cemented sockets in total hip replacement.Clin Orthop Relat Res1976; 121: 20–32.
31.
CarterD.R., VasuR., HarrisW.H.. Stress distributions in the acetabular region–II. Effects of cement thickness and metal backing of the total hip acetabular component.J Biomech1982; 15: 165–70.
32.
CookeN.J., RodgersL., RawlingsD., McCaskieA.W., HollandJ.P.. Bone density of the femoral neck following Birmingham hip resurfacing.Acta Orthop2009; 80: 660–5.
33.
HartyJ.A., DevittB., HartyL.C., MolloyM., McGuinnessA.. Dual energy X-ray absorptiometry analysis of peri-prosthetic stress shielding in the Birmingham resurfacing hip replacement.Arch Orthop Trauma Surg2005; 125: 693–5.
