Preserved proximal femoral bone stock volume in total hip arthroplasty significantly reduces the risk for periprosthetic fractures : a novel modelling technique and preliminary clinical results

Kolar, Matic (author), Mavčič, Blaž (author), Kralj-Iglič, Veronika (author), Antolič, Vane (author)

Periprosthetic proximal femoral fractures (PPFFs) are one of the main causes for revision after total hip arthroplasty (THA), and are associated with some already known patient-/surgical-/implant-related risk factors. Despite the established increased risk of single and double-wedge femoral implants, the highest incidence in our institution has been observed with the anatomical cementless femoral component Anatomic Benoist Girard (ABG) II. The cumulative probability of PPFFs rose from 2.1% at 1 year to 6.5% at 10 years post-implantation, prompting comprehensive and multidisciplinary analysis. A novel parameter of preserved proximal femoral bone stock volume around implanted ABG II femoral stems (V$_{PF}$) and the modelling technique for its evaluation on the standing anteroposterior (AP) hip radiographs were introduced and estimated for each hip. Study was designed according to the standard protocol for matched case-control research. In the preliminary analysis, 5 age-/sex-/implant size-/surgeon-matched stratums, each comprising a case and 2 matched controls, were included. To calculate V$_{PF}$, a mathematical model was constructed by composing parts of rotational bodies and a prism, subject to geometrical parameters of the proximal femur that were assessed from radiographs. The mean value of V$_{PF}$ in the group of cases was 141.6 ± 36.2 cm$^3$ and significantly lower compared to the mean volume of 254.2 ± 33.8 cm$^3$ in the control group (P < 0.01). Based on the preliminary results, the V$_{PF}$ seems crucial for the PPFFs prevention. However, the mechanism of its effect works as a ‘black box’. At this point, it can be hypothesized that insufficient bone stock from the implantation onwards interferes with adequate osseointegration by itself acutely and with increased stress shielding in the long term. The bone stock preservation should be emphasized and considered at all steps, starting from the preoperative planning. The novel parameter in THA, and the method for its evaluation were introduced and are further extensively analysed.

• Language: English
• Keywords: total hip arthroplasty, periprosthetic fracture, bone stock, osseointegration, stress shielding
• Typology: 1.08 - Published Scientific Conference Contribution
• Organization: MF - Faculty of Medicine; ZF - Faculty of Health Sciences
• Publication status: Published
• Publication version: Version of Record
• Year: 2024
• Number of pages: Str. 13-21
• PID: 20.500.12556/RUL-154980
• UDC: 617.3
• DOI: 10.55295/PSL.2024.I3
• COBISS.SI-ID: 188535299
• Publication date in RUL: 12.03.2024

Record is a part of a monograph

• Title: Socratic Lectures : 10th international symposium, Ljubljana, 9. December 2023 : peer reviewed proceedings, part I
• Editors: Veronika Kralj-Iglič, Yelena Istileulova, Anna Romolo
• Place of publishing: Ljubljana
• Publisher: University of Ljubljana Press
• Year: 2024
• ISBN: 978-961-297-266-0
• COBISS.SI-ID: 186758147

Licences

• License: CC BY 4.0, Creative Commons Attribution 4.0 International
• Link: http://creativecommons.org/licenses/by/4.0/
• Description: This is the standard Creative Commons license that gives others maximum freedom to do what they want with the work as long as they credit the author.