Larger femoral periprosthetic bone mineral density decrease following total hip arthroplasty for femoral neck fracture than for osteoarthritis: A prospective, observational cohort study

Abstract

Studies on patients with degenerative joint disease of the hip show that femoral periprosthetic bone mineral decreases following total hip arthroplasty. Scarcely any osteodensitometric data exist on femoral neck fracture (FNF) patients and periprosthetic bone remodelling. In two parallel cohorts we enrolled 87 patients (mean age, 72 AE 12 years; male:female ratio, 30:57) undergoing total hip arthroplasty for either primary osteoarthritis (OA) of the hip (n ¼ 37) or for an acute FNF (n ¼ 50) and followed them for a mean of 5.4 years. Outcomes were bone mineral density (BMD) changes in the periprosthetic Gruen zones 1-7, the incidence of periprosthetic fractures and clinical outcome. The bone mineral loss in the fracture group was more than twice that of the osteoarthritis group, À16.9% versus À6.8% (p ¼ 0.004). The incidence of periprosthetic fractures was 12% (6/50) in the fracture cohort compared with none (0%) in the OA cohort (p ¼ 0.03). Periprosthetic bone mineral loss following total hip arthroplasty is significantly greater in patients who are treated for acute FNF than in OA patients. This decrease of BMD follows a different pattern with the FNF patients losing larger proportions of bone in Gruen zones 1, 2, 6, and 7 while the OA patients tend to have larger losses only in zones 1 and 7. ß

Teriparatide Versus Alendronate for the Preservation of Bone Mineral Density After Total Hip Arthroplasty – A randomized Controlled Trial

“…Although teriparatide administration needs higher cost and relatively difficult compliance compared to alendronate, it may be desirable to use teriparatide at least for patient with hemiarthroplasty after femoral neck fracture. Because the recent evidence with higher risk of BMD loss and periprosthetic fracture after THA for femoral neck fracture compared with osteoarthritis [29], it may be reasonable to prevent second fracture, including periprosthetic fracture and also vertebral compression fracture, for patient after femoral neck fracture with osteoporosis.…”

A Review on Bone Mineral Density Loss in Total Knee Replacements Leading to Increased Fracture Risk

“…It is argued that BMD recovers to a baseline by 2 years [ 74 ], with research showing the greatest loss is within the first 2 years and eventually stabilising at that point [ 75 ], although this in itself has been contested [ 57 , 76 ]. One explanation for this decline in BMD is a reduction in mobility of the patient post-surgery leading to reduced weight bearing and thus disuse related bone loss [ 64 , 77 ]; this potentially explains the trend of such significant BMD reductions in the first 6 months and levelling out at 2 years post-operatively [ 55 ].…”

Perioperative Patient-specific Factors-based Nomograms Predict Short-term Periprosthetic Bone Loss After Total Hip Arthroplasty

“…To the best of our knowledge, our study represented the rst time to use the nomograms in estimating the risk of periprosthetic bone loss. In the present study, variables (age, BMI, implant design, et al) that have been reported to be potential risk factors of postoperative periprosthetic BMD decreaseswere retrospectively collected to create the nomograms [9][10][11][12][13][14]. The concordance index in binary outcomes predicting models represents the ability to distinguish between patients who experience an event from those who do not.…”

“…Many patient-speci c and surgery-related factors were closely related withincreased risk of postoperative prosthetic bone loss, including age [9], body mass index (BMI) [10], primary diagnosis [11], femoral stem design [12], preoperative bone mineral density (BMD) in hip and spine [13], periprosthetic BMD measured in the immediate postoperative period [14], and the administration of anti-osteoporosis agents [5]. Knowledge of these variables, however, only provides the surgeons with an individual factor that improves or worsensspeci c outcome.…”