title: Periprosthetic bone loss after insertion of an uncemented, customized femoral stem and an uncemented anatomical stem. A randomized DXA study with 5-year follow-up.
abstract: OBJECTIVE
  Customized femoral stems are designed to have a perfect fit and fill in the femur in order to achieve physiological load transfer and minimize stress shielding. Dual-energy X-ray absorptiometry (DXA) is regarded as an accurate method for detection of small alterations in bone mineral density (BMD) around hip prostheses. We present medium-term DXA results from a randomized study comparing a customized and an anatomical femoral stem.
  
  
  METHODS
  100 hips were randomized to receive either the anatomical ABG-I stem or the Unique customized femoral stem, both uncemented. DXA measurements were conducted postoperatively and after 3, 6, 12, 24, 36, and 60 months, and BMD was computed for each of the 7 Gruen zones in the proximal femur.
  
  
  RESULTS
  Results from 87 patients were available for analysis. 78 completed the 5-year follow-up: 35 patients in the ABG group and 43 patients in the Unique group. In both groups, we found the greatest degree of bone loss in the proximal Gruen zones. In zone 1, there was 15% reduction in BMD in the ABG-I group and 14% reduction in the Unique group. In zone 7, the reduction was 28% in the ABG-I group and 27% in the Unique group. The only statistically significant difference between the groups was found in Gruen zone 4, which is distal to the tip of the stem, with 1.6% reduction in BMD in the ABG-I group and 9.7% reduction in the Unique group (p = 0.003).
  
  
  CONCLUSIONS
  5-year DXA results showed that because of stress-shielding, proximal bone loss could not be avoided-either for the anatomical ABG-I stem or for the customized Unique stem.
authors.affiliation: Department of Orthopaedic Surgery, Trondheim University Hospital, Trondheim, Norway. mona.nysted@ntnu.no
authors.forename: Mona
authors.initials: M
authors.lastname: Nysted
authors.forename: Pål
authors.initials: P
authors.lastname: Benum
authors.forename: Jomar
authors.initials: J
authors.lastname: Klaksvik
authors.forename: Olav
authors.initials: O
authors.lastname: Foss
authors.forename: Arild
authors.initials: A
authors.lastname: Aamodt
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects; D015519:Bone Density; D001862:Bone Resorption / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006617:Hip Dislocation / Q000601:surgery; D006622:Hip Prosthesis / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000601:surgery; D011474:Prosthesis Design; D011475:Prosthesis Failure; D055815:Young Adult