International Orthopaedics

, Volume 43, Issue 1, pp 71–75 | Cite as

Bone mineral density as a marker of hip implant longevity: a prospective assessment of a cementless stem with dual-energy X-ray absorptiometry at twenty years

  • Giuseppe Sessa
  • Luciano Costarella
  • Calogero Puma Pagliarello
  • Antonio Di Stefano
  • Andrea Sessa
  • Gianluca TestaEmail author
  • Vito Pavone
Original Paper



Bone remodeling around the femoral component after total hip arthroplasty (THA) is considered to be an important factor in long-term stability and seems to be strictly related to the stem design, coating, and fixation. Stress shielding, micro-movement, and high intra-articular fluid pressure might activate macrophages and osteoclasts, causing progressive bone density decreases. Here we analyze the bone mineral density (BMD) around a cementless femoral stem during a 20-year period to better understand the adaptive bone changes around such implants during long-term follow-up.


In this retrospective study, 14 patients treated by THA were reviewed from a cohort of 84. Clinical evaluation with Harris Hip Score and radiographic assessment were performed throughout a 20-year follow-up. To evaluate the bone remodeling around the stem, we monitored the femoral BMD in four regions of interest with a dual-energy X-ray absorptiometry (DEXA) post-operatively and at one, two, three, five and 20 years of follow-up.


The main BMD changes between the post-operative examination and the 20-year follow-up varied between + 11.19% and + 24.30%. Patients with signs of loosening, low Harris Hip Scores, and pain showed decreasing BMD values.


The correlation between the clinical result and BMD values could suggest DEXA results as a predictor of implant loosening or longevity.


Total hip arthroplasty DEXA Cementless stem Prosthetic loosening Periprosthetic BMD 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  1. 1.Department of General Surgery and Medical Surgical Specialties – Section of Orthopaedics and Traumatology, University Hospital “Policlinico-Vittorio Emanuele”University of CataniaCataniaItaly
  2. 2.II Clinic, Biomechanics LaboratoryRizzoli Orthopaedic InstituteBolognaItaly

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