Quantitative Computed Tomography Reflects Vertebral Fracture Morbidity in Osteopenic Patients

Kaplan, Frederick S.; Dalinka, Murray K.; Karp, Joel S.; Fallon, Michael D.; Katz, Michael E.; Boden, Scott D.; Simpson, Emma; Attie, Maurice F.; Haddad, John G.

doi:10.3928/0147-7447-19890701-07

Cited by 7 publications

(2 citation statements)

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“…However, high lateral centeredge angles and low acetabular indices, which require more complex surgical techniques for adequate treatment, are associated with higher rates of revision surgery. 59 Furthermore, we found that labral debridement was associated with an increase in the rate of THA revision for the 3 major surgical techniques analyzed in the present investigation. Schilders et al 111 demonstrated superior outcomes after labral repair as compared with labral debridement in 96 patients with a mean follow-up of 2 years.…”

Section: Discussionmentioning

confidence: 48%

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Revision Surgery and Progression to Total Hip Arthroplasty After Surgical Correction of Femoroacetabular Impingement: A Systematic Review

et al. 2021

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Background: Femoroacetabular impingement (FAI) is a major cause of hip pain in young adults and athletes. Surgical treatment of FAI is recommended in cases of failed nonoperative treatment that have the typical clinical and radiographic findings. At present, the role of risk factors for revision surgery and progression to total hip arthroplasty (THA) in patients with FAI is still unclear. Purpose: To investigate the possible association between (1) rate of revision and progression to THA and (2) patient characteristics, type of lesion, family history of hip disease, type of intervention, radiographic parameters, physical examination, and pre- and postoperative scores. Study Design: Systematic review; Level of evidence, 4. Methods: The present systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. In October 2020, the main online databases were accessed. All articles concerning surgical correction for selected patients with FAI were accessed. Patient characteristics, type of intervention, radiographic parameters, physical examination, and pre- and postoperative scores were assessed. The outcomes of interest were the possible association between these variables and the rate of revision and subsequent progression to THA using a multivariate analysis through the Pearson product-moment correlation coefficient. Results: Data from 99 studies (9357 procedures) were collected. The median follow-up was 30.9 months (interquartile range, 24.0-45.0). The mean ± SD age was 33.4 ± 9.3 years; mean body mass index (BMI), 24.8 ± 4.8; percentage right side, 55.8% ± 8.0%; and percentage female sex, 47.5% ± 20.4%. The overall rate of revision was 5.29% (351 of 6641 patients), while the rate of subsequent progression to THA was 3.78% (263 of 6966 patients). Labral debridement ( P < .0001), preoperative acetabular index ( P = .01), and BMI ( P = .03) all showed evidence of a statistically positive association with increased rates of THA. No other statistically significant associations were found between patient characteristics, type of lesion, family history of hip disease, type of intervention, radiographic parameters, physical examination, or pre- and postoperative scores and the rate of revision and/or progression to THA. Conclusion: Although surgical procedures to treat FAI led to satisfactory outcomes, there was a revision rate of 5.29% in the 9357 procedures in the present systematic review. The rate of progression to THA after a median follow-up of 30 months was 3.78%. Patients who have a higher BMI and/or have a pathologic acetabular index and/or undergo labral debridement during correction of FAI are more at risk for a subsequent THA. We advocate additional education of this patient population in terms of expected outcomes and suggest surgical labral repair instead of debridement if needed.

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Section: Discussionmentioning

confidence: 48%

“…However, high lateral center-edge angles and low acetabular indices, which require more complex surgical techniques for adequate treatment, are associated with higher rates of revision surgery. 59 …”

Section: Discussionmentioning

confidence: 99%

Revision Surgery and Progression to Total Hip Arthroplasty After Surgical Correction of Femoroacetabular Impingement: A Systematic Review

et al. 2021

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When bone mass fails to predict bone failure

Ott

1993

Calcif Tissue Int

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New technology for noninvasive measurement of bone mass has enabled many studies of bone mass and its relationship to fracture, which challenge the view that bone mass is the only relevant factor in the etiology of fractures. Several studies have reported ROC curves that generally show values of about 80%. No convincing evidence suggests that one technique is superior to another. The reported relative risks or odds ratios for a fracture usually range between 1.2 and 2.5 per SD. There is no doubt that the risk of a fracture increases as the bone density decreases. However, even with a low bone mass, the risk of not fracturing a bone over the next year is over 90%. Most of the data suggest that patients with severe vertebral fractures have lower bone mass than those with mild fractures, but some women with similarly low bone mass have mild or no fractures. The weight of the evidence suggests that age has an effect on fracture incidence which is independent of bone mass. Trauma is such a major factor that it is surprising to find almost no studies that have controlled for it. The relationship between bone mass and bone failure is strong, but other factors must also be contributing to the bone failure which, like heart failure or renal failure, is a complex, multifactorial disease.

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Role of trabecular morphology in the etiology of age-related vertebral fractures

Snyder¹,

Piazza²,

Edwards³

et al. 1993

Calcif Tissue Int

155

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Osteoporotic compression fractures of the spine differ from most other age-related fractures in that they usually are associated with minimal trauma and with loads no greater than those encountered during normal activities of daily living. With aging and osteoporosis, there is progressive resorption of bone, resulting in reductions in bone density, thinning of trabeculae, and loss of trabecular contiguity. These changes in trabecular bone structure are associated with losses in bone strength which are disproportionate to the reductions in bone mass alone. To explain this disproportionate loss of bone strength, the prevailing opinion is that density reductions in the vertebral centrum are accompanied by a reduction in the number of trabeculae, by preferential resorption of horizontal trabeculae, and by hypertrophy of the remaining vertical trabeculae. To evaluate this view of vertebral morphology, we performed three-dimensional stereological analysis of trabecular bone extracted from midsagittal sections of first lumbar vertebral bodies from 12 donors spanning an age of 27-81 years. We found that both the number (R2 = 0.63, P < 0.01) and thickness (R2 = 0.91, P < 0.01) of trabeculae decreased linearly with density (as expressed by bone volume fraction) whereas the spacing between the trabeculae (R2 = 0.61, P < 0.01) increased reciprocally. There were more vertical trabeculae with transverse trabeculae at all densities, and the number of vertical trabeculae changed with density at twice the rate of the number of transverse trabeculae (P < 0.001). These data do not support the prevailing view that there is preferential resorption of horizontal trabeculae or hypertrophy of the remaining vertical trabeculae.(ABSTRACT TRUNCATED AT 250 WORDS)

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Quantitative Computed Tomography Reflects Vertebral Fracture Morbidity in Osteopenic Patients

Cited by 7 publications

References 29 publications

Revision Surgery and Progression to Total Hip Arthroplasty After Surgical Correction of Femoroacetabular Impingement: A Systematic Review

Revision Surgery and Progression to Total Hip Arthroplasty After Surgical Correction of Femoroacetabular Impingement: A Systematic Review

When bone mass fails to predict bone failure

Role of trabecular morphology in the etiology of age-related vertebral fractures

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