Suscribirse

Modification of regional bone mineral density due to femoral rasping in cementless proximally fixed total hip arthroplasty - 25/04/20

Doi : 10.1016/j.otsr.2019.11.030 
Ibraheim El-Daly a, , Andres Rondon b, Stefroy Pinto b, Christine Chappard c, Quentin Grimal b, Elhadi Sariali a, b
a Service d’orthopédie, hôpital Pitié-Salpêtrière, 47-83, boulevard de Hôpital, 75013 Paris, France 
b Inserm UMR S 1146, CNRS UMR 7371, laboratoire d’imagerie biomédicale, Sorbonne université, 75006 Paris, France 
c Osteo-Articular Bioengineering and Bioimaging (B2OA) university Denis Diderot, CNRS, 10, avenue de Verdun, 75010 Paris, France 

Corresponding author.

Bienvenido a EM-consulte, la referencia de los profesionales de la salud.
Artículo gratuito.

Conéctese para beneficiarse!

Abstract

Background

Three-dimensional planning (3DP) in total hip arthroplasty using computed tomography (CT) to analyze bone mineral density (BMD) at the stem-femur interface has a high reported accuracy and excellent mid-term results in the literature. However, 3DP does not take into account the effect of femoral rasping on BMD distribution within the rasped cavity. Characterizing the impact of femoral rasping on BMD may help avoid mechanical failures, but this data is not accurately investigated. Therefore, we set out a cadaveric study to identify if: (1) Femoral rasping modified regional BMD in areas considered critical for bone anchorage of cementless metaphyseally fixed anatomic stems. (2) In areas of bone-implant contact with an initial high BMD, does femoral rasping increase BMD?

Hypothesis

Femoral rasping increases BMD in some zones considered critical for bone anchorage of cementless metaphyseally fixed anatomic stems within the rasped femoral cavity.

Methods

Four cadaveric femurs were selected to undergo a rasping procedure similar to surgical techniques used for metaphyseally fixed anatomic stems. Images of femurs before and after rasping were obtained with a micro-CT scanner (pixel size 35μm). BMD values before and after rasping were compared in a trabecular bone ring of 3mm thickness around the cavity created by the rasps, in a region extending 3cm above and 2cm below the middle of the lesser trochanter.

Results

Average BMD increased significantly after rasping in 3 of the 4 femurs (13% (0.27 to 0.30) (p=0.004)), 12% (0.32 to 0.36 (p=0.034)) and 15% (0.4 to 0.46 (p=0.001)), while there was no significant variation in the last femur (0.32 to 0.32 (p>0.05)). Increases in regional BMD were significantly higher in the lateral and medial areas, as well as in the most distal femoral regions. There were significantly lower variations of BMD in regions with initially higher BMD.

Discussion

Current opinion considers trabecular bone debris from femoral rasping to have an impact on final stem position and outcome. Our study has demonstrated an overall positive effect of femoral rasping on BMD in the rasped cavity. Understanding this in the context of 3DP may help avoid mechanical failures such as, suboptimal implant fit, fill, and stability as well as femoral fractures during stem implantation.

Level of evidence

IV, Prospective in vitro study.

El texto completo de este artículo está disponible en PDF.

Keywords : Broaching, BMD, Computed tomography, Planning, Compaction


Esquema


© 2020  Elsevier Masson SAS. Reservados todos los derechos.
Añadir a mi biblioteca Eliminar de mi biblioteca Imprimir
Exportación

    Exportación citas

  • Fichero

  • Contenido

Vol 106 - N° 3

P. 543-550 - mai 2020 Regresar al número
Artículo precedente Artículo precedente
  • Is the economic and social cost of one-stage bilateral hip resurfacing lower than two-stage procedures? Retrospective case-control study of 260 hips
  • Antoine Hoestlandt, Julien Dartus, Cyril Delay, Pierre Martinot, Julien Girard
| Artículo siguiente Artículo siguiente
  • Can primary total hip arthroplasty be performed in an outpatient setting? Prospective feasibility and safety study in 321 patients in a day-surgery unit
  • Erwan Pansard, Shahnaz Klouche, Thomas Bauer, Christophe Ménigaux, Philippe Hardy, Ahmed Moulay Meziane

Bienvenido a EM-consulte, la referencia de los profesionales de la salud.

Mi cuenta


Declaración CNIL

EM-CONSULTE.COM se declara a la CNIL, la declaración N º 1286925.

En virtud de la Ley N º 78-17 del 6 de enero de 1978, relativa a las computadoras, archivos y libertades, usted tiene el derecho de oposición (art.26 de la ley), el acceso (art.34 a 38 Ley), y correcta (artículo 36 de la ley) los datos que le conciernen. Por lo tanto, usted puede pedir que se corrija, complementado, clarificado, actualizado o suprimido información sobre usted que son inexactos, incompletos, engañosos, obsoletos o cuya recogida o de conservación o uso está prohibido.
La información personal sobre los visitantes de nuestro sitio, incluyendo su identidad, son confidenciales.
El jefe del sitio en el honor se compromete a respetar la confidencialidad de los requisitos legales aplicables en Francia y no de revelar dicha información a terceros.


Todo el contenido en este sitio: Copyright © 2024 Elsevier, sus licenciantes y colaboradores. Se reservan todos los derechos, incluidos los de minería de texto y datos, entrenamiento de IA y tecnologías similares. Para todo el contenido de acceso abierto, se aplican los términos de licencia de Creative Commons.