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Related Concept Videos

Bone Remodeling01:40

Bone Remodeling

Bone remodeling is a continuous and balanced process of bone resorption by osteoclasts and bone formation by osteoblasts. In adults, it helps maintain bone mass and calcium homeostasis. While mechanical stress can stimulate turnover as part of the normal maintenance and reparative process, several hormones also regulate bone remodeling.
Bone Remodeling and Repair01:31

Bone Remodeling and Repair

Osteoclasts are cells responsible for bone resorption and remodeling. They originate from hematopoietic progenitor cells present in the bone marrow. Numerous progenitor cells fuse to form multinucleated cells, each with 10-20 nuclei. A single osteoclast has a diameter of 150 to 200 µM. These cells have ruffled borders that break down the underlying bone tissue and release minerals such as calcium into the blood in bone resorption. Osteoclasts cling to bones with their ruffled edges during bone...

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An Efficient and Reproducible Protocol for Distraction Osteogenesis in a Rat Model Leading to a Functional Regenerated Femur
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Randomised trial comparing bone remodelling around two uncemented stems using modified Gruen zones.

René H M ten Broeke1, Roel P M Hendrickx, Pieter Leffers

  • 1Department of Orthopaedic Surgery, Research School Caphri, Maastricht University Medical Centre, Maastricht, The Netherlands. r.ten.broeke@mumc.nl

Hip International : the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
|March 3, 2012
PubMed
Summary

A modified Gruen zone analysis in dual-emission X-ray absorptiometry (DEXA) revealed significant bone mineral density (BMD) differences between hip implant stems. This method improves comparisons of bone remodelling around total hip arthroplasty implants.

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Area of Science:

  • Orthopedic Surgery
  • Biomedical Engineering
  • Radiology

Background:

  • Assessing bone remodelling around total hip arthroplasty (THA) is crucial for implant longevity.
  • Current methods using dual-emission X-ray absorptiometry (DEXA) and standard Regions of Interest (ROI), like Gruen zones, limit comparative analysis of different uncemented stem designs.
  • Standardized ROI definitions are needed for accurate evaluation of implant-induced bone mineral density (BMD) changes.

Purpose of the Study:

  • To compare the efficacy of a modified Gruen zone approach versus standard Gruen zones for assessing BMD changes around two uncemented THA stems.
  • To determine if the modified ROI method can reveal significant differences in bone preservation between Symax(TM) and Omnifit(®) stems.
  • To evaluate the impact of proximal coating on bone remodelling using DEXA over a two-year follow-up.

Main Methods:

  • A randomized clinical trial involving 49 patients comparing Symax(TM) (n=25) and Omnifit(®) (n=24) uncemented stems with proximal coating.
  • DEXA scans were used to measure BMD at two-year follow-up.
  • BMD analysis was performed using both standard Gruen zones and a modified approach ensuring equal ROI length and position (zones 1 and 7) for direct comparison of cancellous and cortical bone.

Main Results:

  • The modified Gruen zones yielded lower BMD values for the Omnifit(®) stem in zone 7 (3.6% decrease, p<0.05) compared to standard zones.
  • The modified ROI analysis revealed a statistically significant difference in bone preservation favouring the Symax(TM) implant, a difference not apparent with standard Gruen zones.
  • This adaptation highlighted significant bone preservation differences between the two stem designs in zone 7.

Conclusions:

  • The modified Gruen zone method provides a more accurate and sensitive assessment of bone remodelling around THA implants.
  • This adaptation is essential for valid comparisons of bone preservation between different uncemented stem designs.
  • The study recommends the use of modified Gruen zones for future DEXA-based assessments of bone remodelling in THA research.