Does bone quality predict loosening of cemented total hip replacements?

Nixon, Matthew; Taylor, Gemma; Sheldon, P.; Iqbal, S. J.; Harper, W. M.

doi:10.1302/0301-620x.89b10.19038

Cited by 68 publications

(50 citation statements)

References 35 publications

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“…Conversely, there are multiple studies that have shown no association between patient obesity (BMI C 30 kg/m 2 ) and aseptic loosening rates [13,27,36,39,57]. Although our study was unable to analyze other host factors, previous studies have associated younger age [4,6,15,21,24,36,41,45,53], increased activity level [11,16,44,52], and tobacco use [20] with increased rates of aseptic loosening. To appropriately analyze whether these host factors have an association with aseptic loosening, future studies should report their raw data regarding the incidence of aseptic loosening with each of these various factors.…”

Section: Discussionmentioning

confidence: 54%

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What Host Factors Affect Aseptic Loosening After THA and TKA?

Cherian

Jauregui

Banerjee

et al. 2015

Clinical Orthopaedics &Amp; Related Research

170

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Background Aseptic loosening is the most common cause for revisions after lower-extremity total joint arthroplasties, however studies differ regarding the degree to which host factors influence loosening. Questions/purpose We performed a systematic review to determine which host factors play a role in the development of clinical and/or radiographic failure from aseptic loosening after (1) THA and (2) TKA. Methods Two searches on THA and TKA, respectively, using four electronic databases (EMBASE, CINAHL Plus, PubMed, and Scopus) were conducted. We identified a total of 209 reports that encompassed nine potential host factors affecting aseptic loosening. Inclusion criteria for consideration of scientific clinical reports were that 20 or more patients were involved, with more than 1-year followup, with at least three studies pertaining to each factor, and at least six of the Methodological Index for Non-randomized Studies criteria met, and with raw data for odds ratio (OR) calculations. Twenty-one studies (16 THA studies with 45,779 hips and five TKA studies with 288 knees, respectively) were used to calculate weighted OR and CIs (using the random effects theory) and study heterogeneity for four different host factors in THAs (male sex, high activity level, obesity defined as BMI C 30 kg/m 2 , and current or former tobacco use) and one factor in TKA (BMI C 30 kg/m 2 ), which were placed in a forest plot. Results For THA, male sex (OR, 1.39; 95% CI, 1.22-1.58; p = 0.001) and high activity level (University of California Los Angeles [UCLA] activity score C 8 points; OR, 4.24; 95% CI, 2.46-7.31; p = 0.001) were associated with aseptic loosening. However, obesity (OR, 1.01; 95% CI, 0.73-1.40; p = 0.96), and tobacco use (OR, 1.96; 95% CI, 0.43-8.97; p = 0.39) were not associated with an increased risk of aseptic loosening after THA with the numbers available. For TKA, we found no host factors associated with loosening. In particular, obesity (BMI C 30 kg/m 2

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Section: Discussionmentioning

confidence: 54%

“…Among modifiable risk factors, multiple factors such as high activity level [3,14,17,30,43,44,48], obesity [2,9,10,34,37,38,43,46,48,51,52], and smoking [10,12,16,17,19,32,35,41] may be associated with an increase in the risk of aseptic loosening after THA.…”

Section: Discussionmentioning

confidence: 99%

What Host Factors Affect Aseptic Loosening After THA and TKA?

Cherian

Jauregui

Banerjee

et al. 2015

Clinical Orthopaedics &Amp; Related Research

170

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“…69 Aside from radiographic imaging studies that seek to qualify and quantify the presence of aseptic loosening via image analysis, other viable avenues have emerged that may prove of some benefit when attempting to evaluate the progression of debrisinduced bone resorption such as dual-energy X-ray absorptiometry (DEXA), morphometric grid analysis of lytic lesion advancement, and radiographic texture analysis (RTA) of trabecular bone patterns. [70][71][72][73] Furthermore, adequate biologic markers of osteolysis must be identified to evaluate the condition's progression to supplement where imaging evaluation has fallen short. One such possibility is the use of peripheral blood levels of CD14 þ CD16 þ monocytes which have proven to be sensitive markers of aseptic loosening.…”

Section: Future Directions Imaging Modalitiesmentioning

confidence: 99%

Review of periprosthetic osteolysis in total joint arthroplasty: An emphasis on host factors and future directions

Beck

Illingworth

Saleh

2011

Journal Orthopaedic Research

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Periprosthetic osteolysis is one of the leading causes of total joint revision procedures. If allowed to progress in the absence of radiographic diagnosis and/or proper medical treatment, osteolysis may result in aseptic loosening yielding failure of the implant and the need for complex revision arthroplasty. The purpose of this review was to assess the current understanding of periprosthetic osteolysis with an emphasis on host factors and future directions. A PubMed search was conducted using the following key words; osteolysis, periprosthetic osteolysis, osteolysis imaging. Pertinent articles, as it pertained to the outline of the review, were selected. Periprosthetic osteolysis stems from numerous risk factors. Osteolysis host characteristic risk factors include gender, body weight, and genetics. Current implant designs have reduced the incidence of this disease; however no current design has been able to replicate the in vivo characteristics and therefore development of wear particles continues to be seen. Advanced methods of imaging diagnosis are on the rise, however early imaging diagnosis is currently ineffective. Pharmacologic intervention appears to be a logical avenue for medical intervention, but no approved drug therapy to prevent or inhibit periprosthetic osteolysis is currently available. Although the rate of periprosthetic osteolysis seems to be decreasing with advances in implant design and increased knowledge of the biological process of wear particle induced osteolysis, the rapid increase in the total number of total joint arthroplasties over the next two decades means that better ways of detecting and treating periprosthetic osteolysis are greatly needed. ß

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“…Osteoporosis and osteoarthritis are not mutually exclusive conditions, and many patients undergoing hip replacement also have unrecognized osteoporosis or deficiency of vitamin D (2). Osteoporosis have 3 major potential complications in total hip arthroplasty (THA): perioperative fracture, an increased risk of periprosthetic fracture (Figure 1), and a risk of late aseptic loosening ( Figure 2) due to mechanical failure of ingrown trabecular bone (3,4). Osteoarthritis is one of the most common joint disorder.…”

Section: Introductionmentioning

confidence: 99%

Total hip replacement in osteoarthritis: the role of bone metabolism and its complications

Bottai

Dell’Osso

Celli

et al. 2015

ccmbm

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SummaryOsteoarthritis is one of the most common joint disorder. For treatment of hip symptomatic osteoarthritis, when conservative medical therapy has failed, total hip arthroplasty (THA) is a successful orthopaedic procedures that reduces pain and improves function and quality of life. Incidence of osteoarthritis is constantly increasing with raising life expectancy. This aging process also has led to an increasing number of patients with osteoporosis who need hip replacement for osteoarthritis. Osteoporosis have 3 major potential complications in total hip arthroplasty: perioperative fracture, an increased risk of periprosthetic fracture, and late aseptic loosening. The purpose of the present study was to examine the effects of osteoporosis on total hip replacement procedure outcome and highlight the importance of adequate study of calcium-phosphorus metabolism in patient candidate for hip surgery, and the need to start a suitable therapy to recover the bone mass before surgery. Bone quality of the hip joint has become an important risk factor limiting the durability of THA.KEY WORDS: total hip replacement; bone metabolism; perioperative and periprosthetic fracture.

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Does bone quality predict loosening of cemented total hip replacements?

Cited by 68 publications

References 35 publications

What Host Factors Affect Aseptic Loosening After THA and TKA?

What Host Factors Affect Aseptic Loosening After THA and TKA?

Review of periprosthetic osteolysis in total joint arthroplasty: An emphasis on host factors and future directions

Total hip replacement in osteoarthritis: the role of bone metabolism and its complications

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