Bone Loss Following Cementless Hemiarthroplasty for the Treatment of Femoral Neck Fracture

Mert, Murat; Ermutlu, Cenk; Ünkar, Ethem Ayhan; Topalhafızoglu, Sertaç; Senel, Ahmet Can; Öztürkmen, Yusuf

doi:10.1007/s43465-019-00009-1

Cited by 5 publications

(7 citation statements)

References 25 publications

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“…Localized treatment responses within the hip may influence the likelihood of fractures initiating or propagating within the affected subregion, and might also have implications for the fixation of orthopedic implants including hip prostheses. (15)(16)(17) Cortical and trabecular bone parameters are typically obtained via imaging modalities that rely on 3D quantitative computed tomography (QCT)-based technologies. Such modalities were not included in ACTIVE or ACTIVExtend, but standard two-dimensional (2D) hip dual energy X-ray absorptiometry (DXA) scans can now be processed using 3D-DXA software to model cortical and trabecular measurements, with results that correlate well with QCT results.…”

Section: Introductionmentioning

confidence: 99%

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Proximal Femur Responses to Sequential Therapy With Abaloparatide Followed by Alendronate in Postmenopausal Women With Osteoporosis by 3D Modeling of Hip Dual‐Energy X‐Ray Absorptiometry (DXA)

Winzenrieth¹,

Kostenuik

Boxberger

et al. 2022

JBMR Plus

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Previous subgroup analyses from the ACTIVE trial in women with postmenopausal osteoporosis (NCT01343004) using threedimensional (3D)-processing of dual X-ray absorptiometry (DXA) scans indicated greater increases in total hip cortical volumetric bone mineral density (Ct.vBMD) and estimated indices of hip strength following 18 months of abaloparatide (ABL) versus placebo or teriparatide. The current post hoc analyses describe hip 3D-DXA data for ACTIVExtend (NCT01657162), in which 18 months of ABL followed by 24 months of alendronate (ABL/ALN) increased hip and spine areal BMD (aBMD) and reduced fracture risk versus placebo (PBO) followed by ALN (PBO/ALN). In an ACTIVExtend subgroup (ABL/ALN, n = 204; PBO/ALN, n = 202), hip DXA scans retrospectively underwent 3D modeling via 3D-Shaper software. Changes from baseline in cortical and trabecular compartments were calculated for total hip and hip subregions (femoral neck, trochanter, and shaft). Estimated strength indices comprising crosssectional moment of inertia, section modulus, and buckling ratio were calculated for each hip subregion. Correlations between bone turnover marker levels at the time of alendronate initiation and subsequent BMD gains with alendronate were also investigated within each group. Total hip trabecular and cortical 3D-DXA parameters increased from baseline in both groups (all p < 0.001), with greater average increases for ABL/ALN versus PBO/ALN (trabecular vBMD: 10.87% versus 4.3%; cortical thickness: 2.32% versus 1.14%; Ct.vBMD: 3.41% versus 1.86%; cortical surface BMD: 5.82% versus 3.0%; all p < 0.001). Strength indices in the ABL/ALN group improved in all subregions versus baseline (all p < 0.0001) and versus PBO/ALN (all p < 0.02). In the ABL/ALN group, collagen type I N-terminal propeptide (P1NP) levels at the time of alendronate initiation correlated with subsequent percent changes in all 3D-DXA parameters with 24 months of alendronate therapy. In conclusion, sequential ABL/ALN or PBO/ALN treatment improves trabecular and cortical 3D-DXA parameters at the hip, as well as strength indices of hip subregions, with greater increases with ABL/ALN versus PBO/ALN.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Proximal Femur Responses to Sequential Therapy With Abaloparatide Followed by Alendronate in Postmenopausal Women With Osteoporosis by 3D Modeling of Hip Dual‐Energy X‐Ray Absorptiometry (DXA)

Winzenrieth¹,

Kostenuik

Boxberger

et al. 2022

JBMR Plus

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“…Regarding clinical scores, Hayashi et al found a correlation between daily activity and periprosthetic BMD in THAs [16]. In contrast, Murat et al found no correlation between the clinical scores and peri-stem BMD in femoral neck fractures [17]. Furthermore, no signi cant differences among the three groups in terms of clinical scores were observed, suggesting that the medullary canal shape did not affect the clinical score in this short follow-up period.…”

Section: Discussionmentioning

confidence: 96%

Relationship between proximal femoral morphology and bone mineral density around the stem and the effects of osteoporosis treatment in patients with femoral neck fracture: a multicentre prospective cohort study

Oe,

Hayashi,

Fukui

et al. 2023

Preprint

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Background This study aimed to classify older patients with femoral neck fractures who underwent hemiarthroplasty using a full hydroxyapatite-collared compaction short stem to evaluate the change in bone mineral density (BMD) around the stem. Methods This multicentre, prospective study included 96 older patients with femoral neck fractures registered for surgery from November of 2018 to October of 2020, who were followed up for 1 year after surgery. The patients were classified into three types according to Dorr classification. The BMD around the stem of each patient was determined based on seven Gruen zones using dual-energy X-ray absorptiometry. Clinical scores were measured concurrently. Further, we compared the BMD change rate around the stem in terms of Dorr classification and clinical scores, and investigated the relationship between osteoporosis treatment intervention and the BMD change rate. Results After excluding patients with missing data, 40 patients were included in the analysis. The BMD change rate in zone 2 was significantly different between Dorr types B and C. Clinical scores did not significantly differ between the three groups. Regarding the relationship between osteoporosis treatment and BMD change rate, the pre-injury intervention group had significantly suppressed BMD change rate decline compared with the post-injury intervention and no-intervention groups in zones 1 and 7. Conclusion Careful follow-up examination is critical when performing hemiarthroplasty in patients with femoral neck fractures of Dorr type C because the BMD change rate may decline postoperatively. Pre-injury osteoporosis intervention therapy may suppress BMD loss around the stem.

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“…Gruen zones have also been applied to femora without implants to generate finite element models for predicting osteoporotic hip fracture risk 18 . Gruen zone 1, the trabecula-rich proximolateral region that includes the greater trochanter, has the lowest BMD around the time of THA and experiences substantial BMD loss after THA 3,5,19-23 . Gruen zone 7, the proximomedial region that includes the calcar and lesser trochanter, also has comparatively low BMD around the time of the THA 18,19,22 and is highly susceptible to postoperative BMD loss 3,5,6,20,21,23,24 .…”

mentioning

confidence: 99%

“…Gruen zone 1, the trabecula-rich proximolateral region that includes the greater trochanter, has the lowest BMD around the time of THA and experiences substantial BMD loss after THA 3,5,19-23 . Gruen zone 7, the proximomedial region that includes the calcar and lesser trochanter, also has comparatively low BMD around the time of the THA 18,19,22 and is highly susceptible to postoperative BMD loss 3,5,6,20,21,23,24 . Low BMD in zone 7 is associated with loose femoral implants 25 and is a main location for intraoperative periprosthetic fractures, which are more common in women and patients >65 years of age 26 .…”

mentioning

confidence: 99%

Effects of Abaloparatide on Bone Mineral Density in Proximal Femoral Regions Corresponding to Arthroplasty Gruen Zones

Sheth,

Smith,

Winzenrieth

et al. 2024

Journal of Bone and Joint Surgery

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Background: Low hip bone mineral density (BMD) in patients who undergo total hip arthroplasty (THA) increases the risk of periprosthetic fractures, implant instability, and other complications. Recently, emphasis has been placed on bone health optimization: treating low BMD prior to a planned orthopaedic implant procedure in an effort to normalize BMD and reduce the potential risk of future complications. Abaloparatide is a U.S. Food and Drug Administration-approved osteoanabolic agent for men and postmenopausal women with osteoporosis and a candidate drug for bone health optimization that, in addition to benefits at the spine, increases hip BMD and reduces nonvertebral fracture risk. We hypothesized that abaloparatide would improve BMD in proximal femoral regions surrounding a virtual THA stem. Methods: This post hoc analysis obtained dual x-ray absorptiometry (DXA) hip scans from 500 randomly selected postmenopausal women with osteoporosis from the Phase-3 Abaloparatide Comparator Trial in Vertebral Endpoints (ACTIVE, NCT01343004) study after 0, 6, and 18 months of abaloparatide (250 patients) or placebo (250 patients). Hip DXA scans underwent 3-dimensional (3D) modeling via 3D-Shaper, followed by virtual resection of the proximal femur and simulated placement of a tapered, flat-wedge hip stem that guided delineation of the Gruen zones that were fully (zones 1 and 7) or largely (zones 2 and 6) captured in the scanning region. Integral, cortical, and trabecular volumetric BMD, cortical thickness, and cortical surface BMD (the product of cortical volumetric BMD and cortical thickness) were determined for each zone. Results: Compared with placebo, the abaloparatide group showed greater increases in integral volumetric BMD in all zones at months 6 and 18; cortical surface BMD in zones 1, 6, and 7 at month 6; cortical thickness, cortical volumetric BMD, and cortical surface BMD in all zones at month 18; and trabecular volumetric BMD in zones 1 and 7 at months 6 and 18. Conclusions: Abaloparatide increases BMD in proximal femoral regions that interact with and support femoral stems, suggesting that abaloparatide may have value for preoperative or potentially perioperative bone health optimization in patients with osteoporosis undergoing THA. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Bone Loss Following Cementless Hemiarthroplasty for the Treatment of Femoral Neck Fracture

Cited by 5 publications

References 25 publications

Proximal Femur Responses to Sequential Therapy With Abaloparatide Followed by Alendronate in Postmenopausal Women With Osteoporosis by 3D Modeling of Hip Dual‐Energy X‐Ray Absorptiometry (DXA)

Proximal Femur Responses to Sequential Therapy With Abaloparatide Followed by Alendronate in Postmenopausal Women With Osteoporosis by 3D Modeling of Hip Dual‐Energy X‐Ray Absorptiometry (DXA)

Relationship between proximal femoral morphology and bone mineral density around the stem and the effects of osteoporosis treatment in patients with femoral neck fracture: a multicentre prospective cohort study

Effects of Abaloparatide on Bone Mineral Density in Proximal Femoral Regions Corresponding to Arthroplasty Gruen Zones

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