The Journal of Bone and Joint Surgery, Vol 77, Issue 2 231-239, Copyright © 1995 by Journal of Bone and Joint Surgery, Inc
Atrophy of the proximal part of the femur after total hip arthroplasty without cement. A quantitative comparison of cobalt-chromium and titanium femoral stems with use of dual x-ray absorptiometry
SS Hughes, JP Furia, P Smith and VD Pellegrini
Department of Orthopaedics, University of Rochester, New York.
The purpose of this study was to compare the density of periprosthetic bone
about titanium and cobalt-chromium stems that had been inserted without
cement. The analysis was done, three to four years after a total hip
arthroplasty, in a retrospectively matched cohort of thirty patients.
Fifteen patients had a stem that was collarless, proximally coated, and
made of titanium; the other fifteen had a stem of similar design that was
made of cobalt-chromium. The criteria for selection in the study included
an excellent clinical and radiographic result and separately calculated
modified Harris and Mayo hip scores of more than 94 points. All stems had
radiographic evidence of osseous ingrowth. A comparison of the bone-mineral
density about the two different types of stem with dual-energy x-ray
absorptiometry revealed a significant difference only along the calcar of
the femur. There was no significant difference about the remaining,
preponderant portion of the proximal part of the femur. Our data suggest
that the difference in the modulus of elasticity between the two types of
stem had little effect on the loss of bone-mineral density in most of the
proximal part of the femur after arthroplasty without cement.
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