title: Progressive femoral cortical and cancellous bone density loss after uncemented tapered-design stem fixation.
abstract: BACKGROUND
  Aseptic implant loosening and periprosthetic bone loss are major problems after total hip arthroplasty (THA). We present an in vivo method of computed tomography (CT) assisted osteodensitometry after THA that differentiates between cortical and cancellous bone density (BD) and area around the femoral component.
  
  
  METHODS
  Cortical and cancellous periprosthetic femoral BD (mg CaHA/mL), area (mm(2)) and contact area between the prothesis and cortical bone were determined prospectively in 31 patients 10 days, 1 year, and 6 years after uncemented THA (mean age at implantation: 55 years) using CT-osteodensitometry.
  
  
  RESULTS
  6 years postoperatively, cancellous BD had decreased by as much as 41% and cortical BD by up to 27% at the metaphyseal portion of the femur; this decrease was progressive between the 1-year and 6-year examinations. Mild cortical hypertrophy was observed along the entire length of the diaphysis. No statistically significant changes in cortical BD were observed along the diaphysis of the stem.
  
  
  CONCLUSIONS
  Periprosthetic CT-assisted osteodensitometry has the technical ability to discriminate between cortical and cancellous bone structures with respect to strain-adapted remodeling. Continuous loss of cortical and cancellous BD at the femoral metaphysis, a homeostatic cortical strain configuration, and mild cortical hypertrophy along the diaphysis suggest a diaphyseal fixation of the implanted stem. CT-assisted osteodensitometry has the potential to become an effective instrument for quality control in THA by means of in vivo determination of periprosthetic BD, which may be a causal factor in implant loosening after THA.
authors.affiliation: Department of Orthopaedic Surgery, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen. ltzmll@aol.com
authors.forename: Lutz A
authors.initials: LA
authors.lastname: Mueller
authors.forename: Tobias E
authors.initials: TE
authors.lastname: Nowak
authors.forename: Lothar
authors.initials: L
authors.lastname: Haeberle
authors.forename: Lars P
authors.initials: LP
authors.lastname: Mueller
authors.forename: Alexander
authors.initials: A
authors.lastname: Kress
authors.forename: Michael
authors.initials: M
authors.lastname: Voelk
authors.forename: David
authors.initials: D
authors.lastname: Pfander
authors.forename: Raimund
authors.initials: R
authors.lastname: Forst
authors.forename: Rainer
authors.initials: R
authors.lastname: Schmidt
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000379:methods; D015519:Bone Density; D016723:Bone Remodeling; D002484:Cementation; D005260:Female; D005500:Follow-Up Studies; D006621:Hip Joint / Q000000981:diagnostic imaging; D006622:Hip Prosthesis / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000601:surgery; D011446:Prospective Studies; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D014057:Tomography, X-Ray Computed