The influence of stem alignment on the bone mineral density around the Polarstem following total hip arthroplasty

Introduction Bone mineral density is important in detecting implant loosening after total hip arthroplasty. The Polarstem can improve postoperative bone mineral density changes, but no information exists on the influence of postoperative stem alignment. Therefore, we investigated the relationship between bone mineral density change and stem alignment following total hip arthroplasty using a cementless Polarstem. Materials and methods This retrospective study included 42 patients (50 hips) who underwent total hip arthroplasty using a cementless Polarstem. Bone mineral density around the stem was measured according to the established Gruen zone classification using dual-energy X-ray absorptiometry. Measurements were performed 2 months postoperatively (baseline) and 6, 12, 18, and 24 months postoperatively. Bone mineral density changes at each follow-up were calculated as (bone mineral density at follow-up/at 2 weeks) x 100 (%). The stem varus, anterior tilt, and anteversion angles were measured using computed tomography. The correlation coefficient between bone mineral density changes and stem alignment were investigated. Results The 24-month postoperative bone mineral density increased in zones 4 (106.0%) and 5 (107.3%) and decreased in zones 1 (89.6%) and 7 (90.6%). The mean stem varus angle, anterior tilt, and anteversion error were - 0.3 degrees +/- 1.8 degrees, 1.9 degrees +/- 2.2 degrees, and 6.8 degrees +/- 5.4 degrees. Negative correlations were observed between the stem varus angle and 24-month postoperative bone mineral density change in zone 1 (r = - 0.34, p = 0.02), and the stem anteversion error and 24-month postoperative bone mineral density change in zone 1 (r = - 0.48, p < 0.01) and zone 7 (r = - 0.31, p = 0.03). Conclusions The cementless Polarstem may have a positive effect on postoperative bone mineral density in the distal femur. However, varus malalignment and anteversion error of the stem could have a negative influence on the bone mineral density changes in the proximal femur.

Automated summary

This study aimed to investigate the relationship between stem alignment and postoperative bone mineral density change following total hip arthroplasty. The results showed that the cementless Polarstem had a positive effect on bone mineral density in the distal femur, but varus malalignment and anteversion error of the stem had a negative influence on bone density changes in the proximal femur.