JBJS - 2026-03-03 - Journal Article
[18F]-Fluoride PET/CT Analyses of Postoperative Bone Mineralization Adjacent to Acetabular Cups in Total Hip Arthroplasty: A Randomized Clinical Trial.
Sotiriou D, Sörensen J, Ullmark G
Topics
Key Takeaway
Trabecular Titanium acetabular cups demonstrated 17% higher periprosthetic metabolic activity (SUV) at 4 weeks post-THA compared to hydroxyapatite-coated cups, suggesting faster early osseointegration.
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Summary
This RCT compared early periprosthetic bone metabolic activity between Trabecular Titanium (TT) and hydroxyapatite (HA)-coated uncemented acetabular cups using [18F]-fluoride PET/CT at 4, 16, and 36 weeks in 28 patients undergoing primary THA. TT cups showed 17% higher SUVs at 4 weeks, indicating greater early mineral accumulation and osseointegration activity. Both cup types exceeded healthy reference acetabulum SUVs at 4 and 16 weeks, with no clinical outcome differences reported at 36 weeks.
Key Limitation
The 36-week endpoint captures only the early healing phase, providing no data on whether the 17% SUV advantage of TT cups translates into superior long-term fixation, reduced aseptic loosening, or improved implant survival.
Original Abstract
BACKGROUND
The longevity of total hip arthroplasty (THA) largely depends on adequate bone formation around the implant. This study used [18F]-fluoride positron emission tomography combined with computed tomography (F-PET/CT) to evaluate skeletal metabolism in the bone surrounding the acetabular cup and to compare the metabolic activity in the periprosthetic regions between cups with 2 different surfaces.
METHODS
Twenty-eight Swedish patients (15 females) with a mean age of 61.3 years were randomly assigned to receive an uncemented cup with either a Trabecular Titanium (TT) surface or a hydroxyapatite (HA) coating. The acetabular bone region surrounding the cup was divided into 9 regions of interest (ROIs). All patients were assessed with use of radiographs and clinical scoring at 36 weeks of follow-up and with use of F-PET/CT at 4, 16, and 36 weeks postoperatively.
RESULTS
F-PET/CT scans demonstrated 17% higher levels of metabolic activity indicating osseointegration in the TT group compared with the HA group at 4 weeks postoperatively. Additionally, both groups had higher standardized uptake values (SUVs) compared with the healthy reference acetabulum groups at 4 and 16 weeks postoperatively.
CONCLUSIONS
A detailed analysis of bone growth on the implant surface revealed that the initial healing phase involves increased mineral accumulation for both TT and HA cups. These findings provide valuable insights into the secondary stabilization of implants, which is critical for prosthesis survival.
LEVEL OF EVIDENCE
Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.