An Ultra-Short Femoral Neck-Preserving Hip Prosthesis: A 2-Year Follow-up Study with Radiostereometric Analysis and Dual X-Ray Absorptiometry in a Stepwise Introduction
BACKGROUND:Total hip arthroplasty (THA) with a diaphyseal stem may risk bone loss. In order to save proximal bone stock in young patients with a high activity level and a long life expectancy, the interest in short stems has evolved. The purpose of this prospective observational cohort study was to...
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| Veröffentlicht in: | Journal of bone and joint surgery. American volume 2020-01, Vol.102 (2), p.128-136 |
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| creator | Christiansen, Janus D. Ejaz, Ashir Nielsen, Poul T. Laursen, Mogens |
| description | BACKGROUND:Total hip arthroplasty (THA) with a diaphyseal stem may risk bone loss. In order to save proximal bone stock in young patients with a high activity level and a long life expectancy, the interest in short stems has evolved. The purpose of this prospective observational cohort study was to evaluate the fixation of, and bone remodeling around, the Primoris femoral neck-preserving hip implant.
METHODS:Fifty younger patients with end-stage osteoarthritis were managed with the Primoris hip implant. We evaluated bone mineral density (BMD) using dual x-ray absorptiometry (DXA) and implant migration using radiostereometric analysis (RSA). A region-of-interest (ROI) protocol for 4 ROIs was applied to assess BMD. The association between BMD and migration was evaluated to determine the fixation of the Primoris implant and bone remodeling in the proximal part of the femur. Follow-up evaluation was performed at regular intervals from day 1 (baseline) until 24 months after surgery.
RESULTS:The major stem migrations were subsidence (Y axis; mean, 0.38 mm) at 6 weeks and varus tilt (rotation) (Z axis; mean, 0.93°) at 6 to 12 months. In ROI4 (the calcar area), a significant gain in bone was found with a mean difference of 4.1% (95% confidence interval [CI], 0.8% to 7.4%; p < 0.02) at 24 months postoperatively. Significant bone loss was found in ROI1 and ROI2, with a mean difference of −4.9% (95% CI, –7.4% to –2.4%; p = 0.0003) and −8.9% (95% CI, −11.5% to –6.2%; p = 0.0001), respectively. Linear regression and multivariate regression analysis showed a significant negative association between maximal total point motion and BMD (p = 0.02, R = 15%; and p < 0.05, R = 26%, respectively).
CONCLUSIONS:The Primoris component showed satisfactory primary stability with promising results at the 24-month follow-up. DXA scans showed limited stress-shielding with the proximal loading pattern of the Primoris. Better bone quality was associated with less implant migration.
LEVEL OF EVIDENCE:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. |
| doi_str_mv | 10.2106/JBJS.19.00104 |
| format | Article |
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METHODS:Fifty younger patients with end-stage osteoarthritis were managed with the Primoris hip implant. We evaluated bone mineral density (BMD) using dual x-ray absorptiometry (DXA) and implant migration using radiostereometric analysis (RSA). A region-of-interest (ROI) protocol for 4 ROIs was applied to assess BMD. The association between BMD and migration was evaluated to determine the fixation of the Primoris implant and bone remodeling in the proximal part of the femur. Follow-up evaluation was performed at regular intervals from day 1 (baseline) until 24 months after surgery.
RESULTS:The major stem migrations were subsidence (Y axis; mean, 0.38 mm) at 6 weeks and varus tilt (rotation) (Z axis; mean, 0.93°) at 6 to 12 months. In ROI4 (the calcar area), a significant gain in bone was found with a mean difference of 4.1% (95% confidence interval [CI], 0.8% to 7.4%; p < 0.02) at 24 months postoperatively. Significant bone loss was found in ROI1 and ROI2, with a mean difference of −4.9% (95% CI, –7.4% to –2.4%; p = 0.0003) and −8.9% (95% CI, −11.5% to –6.2%; p = 0.0001), respectively. Linear regression and multivariate regression analysis showed a significant negative association between maximal total point motion and BMD (p = 0.02, R = 15%; and p < 0.05, R = 26%, respectively).
CONCLUSIONS:The Primoris component showed satisfactory primary stability with promising results at the 24-month follow-up. DXA scans showed limited stress-shielding with the proximal loading pattern of the Primoris. Better bone quality was associated with less implant migration.
LEVEL OF EVIDENCE:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.</description><identifier>ISSN: 0021-9355</identifier><identifier>EISSN: 1535-1386</identifier><identifier>DOI: 10.2106/JBJS.19.00104</identifier><identifier>PMID: 31596796</identifier><language>eng</language><publisher>United States: The Journal of Bone and Joint Surgery, Inc</publisher><subject>Absorptiometry, Photon ; Adolescent ; Adult ; Aged ; Arthroplasty, Replacement, Hip - instrumentation ; Bone Density - physiology ; Bone Remodeling - physiology ; Female ; Femur Neck - physiology ; Femur Neck - surgery ; Follow-Up Studies ; Hip Prosthesis ; Humans ; Male ; Middle Aged ; Osteoarthritis, Hip - physiopathology ; Osteoarthritis, Hip - surgery ; Prospective Studies ; Prosthesis Design ; Prosthesis Failure ; Radiostereometric Analysis ; Young Adult</subject><ispartof>Journal of bone and joint surgery. American volume, 2020-01, Vol.102 (2), p.128-136</ispartof><rights>The Journal of Bone and Joint Surgery, Inc.</rights><rights>Copyright 2020 by The Journal of Bone and Joint Surgery, Incorporated</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3364-311744f4ce3979afe4264f7971021398a24bfbd2f2f69c0cdc2167911fe1effb3</cites><orcidid>0000-0002-3471-6037 ; 0000-0002-2791-3921 ; 0000-0002-4406-5055 ; 0000-0002-0337-3078</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31596796$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Christiansen, Janus D.</creatorcontrib><creatorcontrib>Ejaz, Ashir</creatorcontrib><creatorcontrib>Nielsen, Poul T.</creatorcontrib><creatorcontrib>Laursen, Mogens</creatorcontrib><title>An Ultra-Short Femoral Neck-Preserving Hip Prosthesis: A 2-Year Follow-up Study with Radiostereometric Analysis and Dual X-Ray Absorptiometry in a Stepwise Introduction</title><title>Journal of bone and joint surgery. American volume</title><addtitle>J Bone Joint Surg Am</addtitle><description>BACKGROUND:Total hip arthroplasty (THA) with a diaphyseal stem may risk bone loss. In order to save proximal bone stock in young patients with a high activity level and a long life expectancy, the interest in short stems has evolved. The purpose of this prospective observational cohort study was to evaluate the fixation of, and bone remodeling around, the Primoris femoral neck-preserving hip implant.
METHODS:Fifty younger patients with end-stage osteoarthritis were managed with the Primoris hip implant. We evaluated bone mineral density (BMD) using dual x-ray absorptiometry (DXA) and implant migration using radiostereometric analysis (RSA). A region-of-interest (ROI) protocol for 4 ROIs was applied to assess BMD. The association between BMD and migration was evaluated to determine the fixation of the Primoris implant and bone remodeling in the proximal part of the femur. Follow-up evaluation was performed at regular intervals from day 1 (baseline) until 24 months after surgery.
RESULTS:The major stem migrations were subsidence (Y axis; mean, 0.38 mm) at 6 weeks and varus tilt (rotation) (Z axis; mean, 0.93°) at 6 to 12 months. In ROI4 (the calcar area), a significant gain in bone was found with a mean difference of 4.1% (95% confidence interval [CI], 0.8% to 7.4%; p < 0.02) at 24 months postoperatively. Significant bone loss was found in ROI1 and ROI2, with a mean difference of −4.9% (95% CI, –7.4% to –2.4%; p = 0.0003) and −8.9% (95% CI, −11.5% to –6.2%; p = 0.0001), respectively. Linear regression and multivariate regression analysis showed a significant negative association between maximal total point motion and BMD (p = 0.02, R = 15%; and p < 0.05, R = 26%, respectively).
CONCLUSIONS:The Primoris component showed satisfactory primary stability with promising results at the 24-month follow-up. DXA scans showed limited stress-shielding with the proximal loading pattern of the Primoris. Better bone quality was associated with less implant migration.
LEVEL OF EVIDENCE:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.</description><subject>Absorptiometry, Photon</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Arthroplasty, Replacement, Hip - instrumentation</subject><subject>Bone Density - physiology</subject><subject>Bone Remodeling - physiology</subject><subject>Female</subject><subject>Femur Neck - physiology</subject><subject>Femur Neck - surgery</subject><subject>Follow-Up Studies</subject><subject>Hip Prosthesis</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Osteoarthritis, Hip - physiopathology</subject><subject>Osteoarthritis, Hip - surgery</subject><subject>Prospective Studies</subject><subject>Prosthesis Design</subject><subject>Prosthesis Failure</subject><subject>Radiostereometric Analysis</subject><subject>Young Adult</subject><issn>0021-9355</issn><issn>1535-1386</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc1u1DAURiMEokNhyRZ5ycaD_-JM2IXC0FZVqTpUglXkJNfE1IlTOyHKG_GYeDqFHV1Zuj73u9J3kuQ1JWtGiXx3_uF8t6b5mhBKxJNkRVOeYso38mmyIoRRnPM0PUpehPCTECIEyZ4nR5ymucxyuUp-Fz26saNXeNc6P6ItdM4riy6hvsVXHgL4X6b_gU7NgK68C2MLwYT3qEAMfwfl0dZZ62Y8DWg3Ts2CZjO26Fo1JrLgwXUwelOjold2iZtI9Q36OMUL3_C1WlBRBeeH0dxzCzI9UjEIhtkEQGf96F0z1fG7f5k808oGePXwHic3209fT07xxZfPZyfFBa45lwJzSjMhtKiB51muNAgmhc7yjMYueL5RTFS6aphmWuY1qZua0dgEpRooaF3x4-TtIXfw7m6CMJadCTVYq3pwUygZJzwTcpPJiOIDWsdiggddDt50yi8lJeVeTrmXU9K8vJcT-TcP0VPVQfOP_msjAvQAzM7G8sKtnWbwZQvKju1_Q8UjO2TvXDKOGWGRpynB-1HK_wDmYaur</recordid><startdate>20200115</startdate><enddate>20200115</enddate><creator>Christiansen, Janus D.</creator><creator>Ejaz, Ashir</creator><creator>Nielsen, Poul T.</creator><creator>Laursen, Mogens</creator><general>The Journal of Bone and Joint Surgery, Inc</general><general>Copyright by The Journal of Bone and Joint Surgery, Incorporated</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-3471-6037</orcidid><orcidid>https://orcid.org/0000-0002-2791-3921</orcidid><orcidid>https://orcid.org/0000-0002-4406-5055</orcidid><orcidid>https://orcid.org/0000-0002-0337-3078</orcidid></search><sort><creationdate>20200115</creationdate><title>An Ultra-Short Femoral Neck-Preserving Hip Prosthesis: A 2-Year Follow-up Study with Radiostereometric Analysis and Dual X-Ray Absorptiometry in a Stepwise Introduction</title><author>Christiansen, Janus D. ; Ejaz, Ashir ; Nielsen, Poul T. ; Laursen, Mogens</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3364-311744f4ce3979afe4264f7971021398a24bfbd2f2f69c0cdc2167911fe1effb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Absorptiometry, Photon</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Arthroplasty, Replacement, Hip - instrumentation</topic><topic>Bone Density - physiology</topic><topic>Bone Remodeling - physiology</topic><topic>Female</topic><topic>Femur Neck - physiology</topic><topic>Femur Neck - surgery</topic><topic>Follow-Up Studies</topic><topic>Hip Prosthesis</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Osteoarthritis, Hip - physiopathology</topic><topic>Osteoarthritis, Hip - surgery</topic><topic>Prospective Studies</topic><topic>Prosthesis Design</topic><topic>Prosthesis Failure</topic><topic>Radiostereometric Analysis</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Christiansen, Janus D.</creatorcontrib><creatorcontrib>Ejaz, Ashir</creatorcontrib><creatorcontrib>Nielsen, Poul T.</creatorcontrib><creatorcontrib>Laursen, Mogens</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of bone and joint surgery. American volume</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Christiansen, Janus D.</au><au>Ejaz, Ashir</au><au>Nielsen, Poul T.</au><au>Laursen, Mogens</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>An Ultra-Short Femoral Neck-Preserving Hip Prosthesis: A 2-Year Follow-up Study with Radiostereometric Analysis and Dual X-Ray Absorptiometry in a Stepwise Introduction</atitle><jtitle>Journal of bone and joint surgery. American volume</jtitle><addtitle>J Bone Joint Surg Am</addtitle><date>2020-01-15</date><risdate>2020</risdate><volume>102</volume><issue>2</issue><spage>128</spage><epage>136</epage><pages>128-136</pages><issn>0021-9355</issn><eissn>1535-1386</eissn><abstract>BACKGROUND:Total hip arthroplasty (THA) with a diaphyseal stem may risk bone loss. In order to save proximal bone stock in young patients with a high activity level and a long life expectancy, the interest in short stems has evolved. The purpose of this prospective observational cohort study was to evaluate the fixation of, and bone remodeling around, the Primoris femoral neck-preserving hip implant.
METHODS:Fifty younger patients with end-stage osteoarthritis were managed with the Primoris hip implant. We evaluated bone mineral density (BMD) using dual x-ray absorptiometry (DXA) and implant migration using radiostereometric analysis (RSA). A region-of-interest (ROI) protocol for 4 ROIs was applied to assess BMD. The association between BMD and migration was evaluated to determine the fixation of the Primoris implant and bone remodeling in the proximal part of the femur. Follow-up evaluation was performed at regular intervals from day 1 (baseline) until 24 months after surgery.
RESULTS:The major stem migrations were subsidence (Y axis; mean, 0.38 mm) at 6 weeks and varus tilt (rotation) (Z axis; mean, 0.93°) at 6 to 12 months. In ROI4 (the calcar area), a significant gain in bone was found with a mean difference of 4.1% (95% confidence interval [CI], 0.8% to 7.4%; p < 0.02) at 24 months postoperatively. Significant bone loss was found in ROI1 and ROI2, with a mean difference of −4.9% (95% CI, –7.4% to –2.4%; p = 0.0003) and −8.9% (95% CI, −11.5% to –6.2%; p = 0.0001), respectively. Linear regression and multivariate regression analysis showed a significant negative association between maximal total point motion and BMD (p = 0.02, R = 15%; and p < 0.05, R = 26%, respectively).
CONCLUSIONS:The Primoris component showed satisfactory primary stability with promising results at the 24-month follow-up. DXA scans showed limited stress-shielding with the proximal loading pattern of the Primoris. Better bone quality was associated with less implant migration.
LEVEL OF EVIDENCE:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.</abstract><cop>United States</cop><pub>The Journal of Bone and Joint Surgery, Inc</pub><pmid>31596796</pmid><doi>10.2106/JBJS.19.00104</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-3471-6037</orcidid><orcidid>https://orcid.org/0000-0002-2791-3921</orcidid><orcidid>https://orcid.org/0000-0002-4406-5055</orcidid><orcidid>https://orcid.org/0000-0002-0337-3078</orcidid></addata></record> |
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| subjects | Absorptiometry, Photon Adolescent Adult Aged Arthroplasty, Replacement, Hip - instrumentation Bone Density - physiology Bone Remodeling - physiology Female Femur Neck - physiology Femur Neck - surgery Follow-Up Studies Hip Prosthesis Humans Male Middle Aged Osteoarthritis, Hip - physiopathology Osteoarthritis, Hip - surgery Prospective Studies Prosthesis Design Prosthesis Failure Radiostereometric Analysis Young Adult |
| title | An Ultra-Short Femoral Neck-Preserving Hip Prosthesis: A 2-Year Follow-up Study with Radiostereometric Analysis and Dual X-Ray Absorptiometry in a Stepwise Introduction |
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