We present a study using Fluoride-Positron Emission Tomography (F-PET/CT) to analyse new bone formation in periacetabular bone adjacent to press fit cups following THA.
In 16 THA (8 patients) with bilateral hip osteoarthritis simultaneous bilateral total hip arthroplasty (THA) was performed, employing electrochemically applied calcium phosphate coated (HA) cups or porous-coated (PC) cups allocated at random to compare the two sides. A reference group of 13 individuals with a normal healthy hip was used to determine ‘normal’ bone metabolism. [18F]fluoride -PET/CT was used to analyze bone formation adjacent to the cups 1 week, 4 months and 12 months after surgery. Clinical and radiographic evaluation was performed preoperatively, postoperatively and at 2 years.
Bone forming activity had a mean of 5.71, 4.69 and 3.47 SUV around the HA- and 5.04, 4.80 and 3.50 SUV around the PC-cups at 1 week, 4 months and 12 months respectively. Normal bone metabolism was 3.68 SUV. After 1 year activity had declined to normal levels for both groups. The clinical results were good in all cases.
HA coating resulted in higher uptake indicating higher bone forming activity after 1 week. F-PET/CT is a valuable tool to analyse bone formation and secondary stabilisation of an acetabular cup.
GoosenJ.H., KumsA.J., KollenB.J., VerheyenC.C.Pourus-Coated femoral components with or without hydroxyapatite in primary uncemented total hip arthroplasty: systemic review of randomized controlled trials.Arch Orthop Trauma Surg2009; 129: 1165–9.
2.
SöballeK.Hydroxyapatite ceramic coating for bone fixation. Mechanical and histological studies in dogs.Acta Orthop Scand Suppl1993; 255: 1–58.
3.
HamadoucheM., WitvoetJ., PorcherR., MeunierA., SedelL., NizardR.Hydroxyapatite-coated versus grit-blasted femoral stems. A prospected, randomized study using EBRA-FCA.J Bone Joint Surg Br2001; 83: 979–87.
4.
LazarinisS., KärrholmJ., HailerN.P.Increased risk of revision of acetabular cups coated with hydroxyapatite.Acta Orthop2010; 81: 53–9.
5.
SandénB., OlerudC., Petrén-MallminM., LarssonS.Hydroxyapatite coating improves fixation of pedicle screws. A clinical study.J Bone Joint Surg Br2002; 84: 387–91.
6.
CoathupM.J., BlunnG.W., FlynnN., WilliamsC., ThomasN.P.A comparison of bone remodelling around hydroxyapatite-coated and grit-blasted hip replacements retrieved at postmortem.J Bone Joint Surg Br2001; 83: 118–23.
7.
CoathupM.J., BlackburnJ., GoodshipA.E., CunninghamJ.L., SmithT., BlunnG.W.Role of hydroxyapatite coating in resisting wear particle migration and osteolysis around acetabular components.Biomaterials2005; 26: 4161–9.
8.
HawkinsR.A., ChoiY., HuangS.C.Evaluation of the skeletal kinetics of fluorine-18-fluoride ion with PET.J Nucl Med1992; 33: 633–42.
9.
PiertM., WinterE., BeckerG.A.Allogenic bone graft viability after hip revision arthroplasty assessed by dynamic [18F]fluoride ion positron emission tomography.Eur J Nucl Med1999; 26: 615–24.
10.
SörensenJ., UllmarkG., LångströmB., NilssonO.Rapid bone and blood flow formation in impacted morcelized allografts.Acta Orthop Scand2003; 74: 633–43.
11.
UllmarkG., SörensenJ., LångströmB., NilssonO.Bone regeneration 6 years after impaction bone grafting: a PET analysis.Acta Orthop2007; 78: 201–6.
12.
UllmarkG., SörensenJ., NilssonO.Bone healing of severe acetabular defects after revision arthroplasty.Acta Orthop2009; 80: 179–83.
13.
UllmarkG., SörensenJ., KärrholmJ.Bone metabolism following revision THA using a distally fixed, tapered and fluted stem. Pilot studies using positron emission tomography, dual-energy X-ray absorptiometry and radiostereometry.Hip Int2011; 21: 30–8.
14.
TemmermanO.P., RaijmakersP.G., HeyligersI.C.Bone metabolism after total hip revision surgery with impacted grafting: evaluation using H2 15O and [18F]fluoride PET; a pilot study.Mol Imaging Biol2008; 10: 288–93.
15.
MessaC., GoodmanW.G., HohC.K.Bone metabolic activity measured with positron emission tomography and [18F]fluoride ion in renal osteodystrophy: correlation with bone histomorphometry.J Clin Endocrinol Metab1993; 77: 949–55.
16.
GrantF.D., FaheyF.H., PackardA.B., DavisR.T., AlaviA., TrevesS.T.Skeletal PET with 18F-fluoride: applying new technology to an old tracer.J Nucl Med2008; 49: 68–78.
17.
PiertM., TilmanT., ZittelG.A.Assessment of porcine bone metabolism by dynamic 18F-fluoride ion PET: correlation with bone histomorphometry.J Nucl Med2001; 42: 1091–100.
18.
AndersonH.C.Matrix vesicles and calcification.Curr Rheumatol Rep2003; 5: 222–6.
19.
ToegelS., HoffmannO., WadsakW.Uptake of bone-seekers is solely associated with mineralisation! A study with 99mTc-MDP, 153Sm-EDTMP and 18F-fluoride on osteoblasts.Eur J Nucl Med Mol Imaging2006; 33: 491–4.
20.
CharnleyJ.Numerical grading of clinical results. In: CharnleyJ., ed. Low friction arthroplasty of the hip: theory and practice.Berlin: Springer-Verlag1979; 20–4.
21.
DeLeeJ.G., CharnleyJ.Radiological demarcation of cemented sockets in total hip replacement.Clin Orthop Relat Res1976; 121: 20–32.
22.
RothmanK.J.No adjustments are needed for multiple comparisons.Epidemiology1990; 1: 43–6.
23.
BauerT.W., StulbergB.N., MingJ., GeesinkR.G.Uncemented acetabular components. Histologic analysis of retrieved hydroxyapatite-coated and porous implants.J Arthroplasty1993; 8: 167–77.
24.
ToninoA., OosterbosC., RahmyA., ThèrinM., DolyeC.Hydroxyapatite-coated acetabular components. Histological and histomorphometric analysis of six cups retrieved at autopsy between three and seven years after successful implantation.J Bone Joint Surg Am2001; 83: 817–25.
25.
MullajiA.B., ToddR.C., RobinsonS., CritchleyM.Quantitative bone scanning after asymptomatic Charnley arthroplasty.Acta Orthop Scand1994; 65: 276–80.
26.
RosenthallL.Hip and knee prostheses: evaluation of the natural history of periprosthetic bone changes.Semin Nucl Med1997; 27: 346–54.
27.
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.
28.
LaursenM.B., NielsenP.T., SøballeK.Bone remodelling around HA-coated acetabular cups: a DEXA study with a 3-year follow-up in a randomized trial.Int Orthop2007; 31: 199–204.
