Bone mineral density and biochemical markers of bone turnover in aseptic loosening after total hip arthroplasty

Abstract

The aims of this study were to determine whether subjects with aseptic loosening after total hip arthroplasty (THA) have regional differences in periprosthetic bone mineral density (BMD) and systemic biochemical markers of bone turnover compared to subjects with successful implants.Proximal femoral and pelvic BMD were measured by dual energy X-ray absorptiometry and bone turnover markers were assayed in 49 subjects 12.6 f 4.3 (mean f SD) years after cemented THA. Femoral BMD was lower in Gruen zones 2, 5, 6, and 7 in subjects with a loose femoral implant ( n = 17) compared to those ( n = 32) with fixed femoral implants ( P < 0.05 all comparisons). This BMD difference was greatest (-3l'%, P = 0.02) in the proximal and medial region of the femur. Subjects with femoral loosening had higher levels of the bone resorption marker N-telopeptides of type-I collagen ( P = 0.02) than those with a fixed femoral implant. N o diferences in pelvic BMD or bone turnover markers were found between subjects with loose ( n = 18) versus fixed (17 = 31) pelvic implants. This study suggests that failure of femoral components after cemented THA is associated with region-specific decreases in BMD and an increase in urinary excretion of N-telopeptide cross-links of type-I collagen. These surrogate outcome markers may be of value in monitoring response to antiresorptive therapies used to treat periprosthetic osteolysis, although the diagnosis of aseptic loosening remains clinical and radiological.

Differences in stability and bone remodeling between a customized uncemented hydroxyapatite coated and a standard cemented femoral stem A randomized study with use of radiostereometry and bone densitometry

“…Some studies following patients up to 10 years have shown a progressive recovery or a minimal loss of BMD after the first to second postoperative year [ 16,20,30,34]. A different pattern of BMD changes has been found around loosened implants [9,23,31,32]. The importance of the early (1-2 years) bone resorption that we and others have found around fixed stems is not known.…”

Biochemical markers of bone turnover in aseptic loosening in hip arthroplasty

“…The measurement of biochemical bone markers reflects the degradation of collagen and provides a valid estimate of the rate of bone resorption. Although a small number of studies have investigated biochemical markers of bone resorption in aseptic failure of THA [1,16,20,[23][24][25], the findings have been contradictory, and a real breakthrough has yet to occur. In addition, no study has assessed the urinary excretion level of type-I collagen crosslinked C-telopeptides (CTX I) as a noninvasive indicator of aseptic loosening of THA.…”

Detection of bony defects around cementless acetabular components in total hip arthroplasty: A DEXA study on 10 human cadavers

“…The precision of the measurements, and the correlation between the measured decrease in BMC and the actual amount of bone removed was very high in our experiments. Our main conclusion is that in DEXA scanning of the periacetabular bone around cementless hemispherical metal-backed cups, the 4-ROI model (Wilkinson et al 2001(Wilkinson et al , 2003 provides a sensitive measure of changes in bone mineral content. Clinically, this provides assistance in detection of osteolytic lesions, which contrasts with the ability of standard radiographs (Engh et al 2000).…”