Longitudinal evaluation of time related bone remodeling after cementless total hip arthroplasty

Bone remodeling after cementless total hip arthroplasty was evaluated by dual energy x-ray absorptiometry in a longitudinal study of 32 hips. After insertion of a fully porous surface anatomic stem made of cobalt chromium, bone mineral density was analyzed until at least 2 years postoperatively. Bone remodeling was evaluated in terms of regional bone density changes in the seven adjacent periprosthetic zones as well as the global change in bone density distribution over the entire periprosthetic area. At 12 months after the operation, the averaged regional bone mineral density in all seven zones showed a rapid decrease, ranging from 9% to 24% of the bone mineral density present at 2 weeks postoperatively. Thereafter, the bone density change appeared to be stabilized. The global change in the bone density distribution was expressed as two summarizing statistical indexes derived from principal component analysis: the first index represents the change of average bone mineral density over the entire periprosthetic area, and the second represents the severity of bone mineral density decrease in the proximal area versus the distal area. The second index proved that more bone density reduction occurred in the proximal area, but this was variable among patients and correlated significantly with the stem size and the initial bone mineral density in the distal part of the periprosthetic area. This longitudinal dual energy x-ray absorptiometry study suggests that a large part of the bone remodeling after cementless hip arthroplasty ceases within 1 year postoperatively, and stem size and the initial bone density around the distal portion are important considerations for predicting the proximal bone density decrease during the early rapid remodeling period.