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The influence of stem alignment on the bone mineral density around the Polarstem following total hip arthroplasty

  • Hip Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Bone mineral density is important in detecting implant loosening after total hip arthroplasty. The Polarstem can improve postoperative bone mineral density changes, but no information exists on the influence of postoperative stem alignment. Therefore, we investigated the relationship between bone mineral density change and stem alignment following total hip arthroplasty using a cementless Polarstem.

Materials and methods

This retrospective study included 42 patients (50 hips) who underwent total hip arthroplasty using a cementless Polarstem. Bone mineral density around the stem was measured according to the established Gruen zone classification using dual-energy X-ray absorptiometry. Measurements were performed 2 months postoperatively (baseline) and 6, 12, 18, and 24 months postoperatively. Bone mineral density changes at each follow-up were calculated as (bone mineral density at follow-up/at 2 weeks) × 100 (%). The stem varus, anterior tilt, and anteversion angles were measured using computed tomography. The correlation coefficient between bone mineral density changes and stem alignment were investigated.

Results

The 24-month postoperative bone mineral density increased in zones 4 (106.0%) and 5 (107.3%) and decreased in zones 1 (89.6%) and 7 (90.6%). The mean stem varus angle, anterior tilt, and anteversion error were − 0.3° ± 1.8°, 1.9° ± 2.2°, and 6.8° ± 5.4°. Negative correlations were observed between the stem varus angle and 24-month postoperative bone mineral density change in zone 1 (r = − 0.34, p = 0.02), and the stem anteversion error and 24-month postoperative bone mineral density change in zone 1 (r = − 0.48, p < 0.01) and zone 7 (r = − 0.31, p = 0.03).

Conclusions

The cementless Polarstem may have a positive effect on postoperative bone mineral density in the distal femur. However, varus malalignment and anteversion error of the stem could have a negative influence on the bone mineral density changes in the proximal femur.

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Acknowledgements

We would like to thank Editage (www.editage.com) for English language editing

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Author notes

  1. Masahiro Fujita, Shinya Hayashi, Shingo Hashimoto, Yuichi Kuroda, Ryosuke Kuroda and Tomoyuki Matsumoto have contributed to the present study equally.

Authors and Affiliations

  1. Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017, Japan

    Masahiro Fujita, Shinya Hayashi, Shingo Hashimoto, Yuichi Kuroda, Ryosuke Kuroda & Tomoyuki Matsumoto

Authors
  1. Masahiro Fujita
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  2. Shinya Hayashi
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  3. Shingo Hashimoto
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  4. Yuichi Kuroda
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  5. Ryosuke Kuroda
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  6. Tomoyuki Matsumoto
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All authors contributed to the present study equally.

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Correspondence to Shinya Hayashi.

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Fujita, M., Hayashi, S., Hashimoto, S. et al. The influence of stem alignment on the bone mineral density around the Polarstem following total hip arthroplasty. Arch Orthop Trauma Surg 143, 3621–3627 (2023). https://doi.org/10.1007/s00402-022-04607-x

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  • DOI: https://doi.org/10.1007/s00402-022-04607-x

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