Five-year DEXA study of 88 hips with cemented femoral stem

Abstract

We performed repeated dual-energy X-ray absorptiometry (DEXA) measurements over five years in a homogeneous patient population to study the effect of a cemented stem on proximal femoral bone remodelling. Data from 88 patients (88 hips) implanted with total hip arthroplasty (THA) prostheses were extracted from three randomised studies. Femoral bone mineral density (BMD) was measured using a Lunar DPX-IQ densitometer for five years postoperatively. At one year the BMD changes had decreased between −2.0% [region of interest (ROI) 1] and −11.5% (ROI 7). During the follow-up period the BMD initially increased during the second year and thereafter decreased again in ROIs 5, 6 and 7. The loss of BMD at five years was more pronounced in region 7 (12.9%) and decreased with increasing age, total hip replacement (THR) on the right side and decreasing weight of the patient. We found that after the initial phase of early bone loss a period of recovery follows. Thereafter the BMD decreases again, which probably reflects the normal ageing of bone after uncomplicated cemented THA.Résumé Nous avons réalisé des examens avec des mesures répétées de densité osseuse (DEXA) sur une période de 5 ans dans une population homogène de patients ayant bénéficié de la mise en place d'une prothèse fémorale cimentée avec évaluation de remodelage osseux. Nous avons extrait les données de 88 patients (88 hanches) de trois études randomisées. La densité minérale osseuse fémorale a été mesurée par densitomètre Lunar DPX-IQ durant les cinq années post-opératoires. A un an, la densité minérale osseuse diminue de −2% (zone 1) et de −11,5% (zone 7). Durant la période d'observation la densité minérale osseuse augmente au cours de la deuxième année et puis diminue à nouveau en zones 5, 6 et 7. La perte de densité osseuse à cinq ans est moins importante en zone 7 (12,9%) et diminue lorsque l'âge augmente notamment du côté droit et en fonction du poids des patients. Nous avons ainsi montré, qu'après une phase initiale de déminéralisa-tion osseuse il existe une phase de reminéralisation puis la densité minérale osseuse diminue à nouveau ceci étant probablement dans les prothèses totales de hanches non compliquées le reflet de l'âge.

Periprosthetic bone mineral density with a cementless triple tapered stem is dependent on daily activity

“…The negative correlation between BMD and aging is well documented [22]. Further, positive correlation between BMD and body weight was reported [17,18]. Yamauchi et al reported that leptin directly stimulates osteoblast differentiation.…”

“…Several studies demonstrated a relationship between BMD and HHS, age or BMI [17][18][19]. Korovessis demonstrated no correlation between age and periprosthetic BMD changes [20].…”

Activity and Loading Influence the Predicted Bone Remodeling Around Cemented Hip Replacements

“…Clinical data suggests that a condition close to homeostasis is established after 2-3 years for both cemented [2,3,40] and cementless total hip replacements [20,41,42], with slight changes at 5-7 years. Therefore, the time constant (T) was fitted such that 90% of the BMD change in the most active Gruen Zone, 7, had completed at 2 years (Fig.…”

Delayed Administration of Risedronate Does Not Restore Bone Loss In Patients Following Total Hip Arthroplasty - A randomized, double blinded clinical study

“…As such, all levels of risk factors would be provide more merit for the efficacy of proactive intervention of bisphosphonates similar to what the original bisphosphonate literatures depicted. [7,16,19] Therefore, no control over BMD was used to represent a more real world cross section of what a typical trauma practice would see in an emergency room where BMD's are simply unavailable. The study protocol received full approval from Institutional Review Board, Patient Advocacy Council, Inc.…”

“…However, clinical evidence suggests that the short-term gains of bisphosphonate therapy may not be sustained in the long term or reversed once they have occurred. [17,19,20,21] Although the benefits of risedronate administration on enhancing periprosthetic BMD have been observed in the first year post-THA, currently, there is no evidence to show that the risedronate therapy may reverse the delayed periprosthetic bone loss occurring after the initial post-operative year. We hypothesized that oral risedronate may augment or prevent bone loss in well osteointegrated patients following THA, just as it has been demonstrated in recent postoperative THA patients.…”