Late remodeling around a proximally HA-coated tapered titanium femoral component

Most bone remodeling is thought to occur within the first few years after THA. Loss of bone density later may be associated with stress shielding or normal bone loss of aging. We evaluated remodeling changes over time with a proximally hydroxyapatite-coated tapered titanium stem. We evaluated plain radiographs of 143 hips for cancellous condensation, cortical hypertrophy, cortical porosis, cortical index, and canal fill at early postoperative, 5, 10, and 15 years. Average age was 51 years at THA; 69 patients (77 hips) (53%) were women; and 102 hips (71%) had primary osteoarthrosis. Based on radiographic findings at 15 years, hips were divided into three subgroups: 43 (30%) demonstrated minimal remodeling changes; 53 (37%) demonstrated cortical hypertrophy evident before 5 years; and 47 (33%) demonstrated additional late remodeling and cortical porosis, most often after 10 years. Hips with poorer bone (Dorr Types B or C) and, when including only hips with osteoarthrosis, more female hips had cortical porosis at 15 years. Late radiographic changes in patients with porosis appear more similar to that associated with an extensively rather than proximally coated stem. Whether continued bone adaptation and bone loss of aging will eventually threaten implant stability is unknown, but at 15 years, all 143 implants remained well fixed and clinically asymptomatic.

Level III, retrospective study. See the Guidelines for Authors for a complete description of levels of evidence.