Bone Strength Influences Periprosthetic Bone Loss after Hip Arthroplasty

Arabmotlagh, Mohammad; Hennigs, T; Warzecha, Joerg; Rittmeister, M.

doi:10.1097/01.blo.0000176148.39380.ff

Cited by 6 publications

(5 citation statements)

References 24 publications

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“…Patients in the placebo group with low pre-operative bone mass had lost 23% and 27% in zones 1 and 7 of the operated hip after 2 years, whereas patients with high systemic BMD lost only 14% and 11% respectively. This is consistent with results from earlier studies showing a correlation between low preoperative bone mass and increased bone loss around uncemented stems (33,220). Another factor influencing periprosthetic BMD was the stem diameter.…”

Section: Periprosthetic Bone Mineral Changessupporting

confidence: 91%

The Effect of Weekly Risedronate on Periprosthetic Bone Resorption Following Total Hip Arthroplasty

Sköldenberg

Salemyr

Bodén

et al. 2011

Journal of Bone and Joint Surgery

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Risedronate taken once weekly for six months following total hip arthroplasty was effective in reducing periprosthetic bone resorption around an uncemented femoral stem up to one year after surgery but had no discernible effect on implant migration or clinical outcome. Future studies of bisphosphonate treatment following total hip arthroplasty should focus on clinically relevant end points such as the risks of fracture and revision arthroplasty.

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Section: Periprosthetic Bone Mineral Changessupporting

confidence: 91%

The Effect of Weekly Risedronate on Periprosthetic Bone Resorption Following Total Hip Arthroplasty

Sköldenberg

Salemyr

Bodén

et al. 2011

Journal of Bone and Joint Surgery

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“…6,50 The greatest change tends to be in the proximal zones with a wide spread of results in zone 1. 7,8,12,40,41,[47][48][49]51 Nivbrant et al, 49 comparing the Lubinus SPII with an SHP prosthesis, found a 9% loss for the former and 1% in the latter in zone 1, with a reported range of results in this study from À31 to þ40% in the Lubinus and À19 to þ17% in the SHP. Grant 41 reported a similarly wide range of results (À5 to þ37%) in a DXA study of the elite stem.…”

Section: Discussionmentioning

confidence: 72%

“…16,39 Its potential effects on THA studies have rarely been acknowledged. Arabmotlagh 40 suggested that preservation of BMD in zone 1 of some of their study group might have been due to the effects of HO, and a recent study examining femoral remodeling excluded a patient with ''extensive'' HO from analysis. 41 However, our study shows that merely excluding ''extensive'' HO is insufficient, as even mild HO produces a significant effect.…”

Section: Discussionmentioning

confidence: 99%

Impact of trochanteric heterotopic ossification on measurement of femoral bone density following cemented total hip replacement

Downing

Knox

Gibson

et al. 2008

Journal Orthopaedic Research

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During a study of bone mineral density changes around cemented femoral implants, we recognized heterotopic ossification occurring regularly in a position anterior to the greater trochanter and proximal femur. The aim of this study was to describe the incidence, distribution, and effect of this ossification on periprosthetic DXA scans following primary cemented total hip replacement. One hundre eleven patients underwent postoperative DXA examinations measuring changes in bone mineral density with heterotopic ossification identified and localized on standard radiographs with confirmation using DXA subtraction imaging. Male gender and age within the male group were significantly associated with occurrence of heterotopic ossification (p ¼ 0.003 and 0.046, respectively). Femoral stem type, weight, and body mass index had no significant effect (p ¼ 0.525, 0.372, and 0.243, respectively). Examining the Gruen zones in all patients suggested a median (plus interquartile range) zone 1 density drop of 4% (À12% to þ7%). When separated and analyzed for the effect of heterotopic ossification, the 45 patients with heterotopic ossification showed a 2-year density gain of þ6% (À5% to þ15%), whereas those without heterotopic ossification showed a loss of 8% (À14% to 0%), a significant difference (p < 0.001). Zone 2 also showed a significant difference (p ¼ 0.048). We therefore recommend that affected zones should be identified and excluded from analysis at all time points. Without this precaution, researchers risk underestimating periprosthetic bone loss in their studies and reporting misleading conclusions. ß

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“…We used a multiple linear regression analysis to analyze which factors influenced bone loss in the entire periprosthetic region at 4 years. Factors separately investigated in the analysis was exposure (OA vs. fracture) and covariates who, from other studies, are known to influence bone remodeling around implants (preoperative bone mineral density in the hip, sex, age, body mass index, and stem size) . Pearsońs Chi‐squared test was used to compare the categorical variables between the groups.…”

Section: Methodsmentioning

confidence: 99%

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

Mann

Eisler

Bodén

et al. 2015

Journal Orthopaedic Research

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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

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Bone Strength Influences Periprosthetic Bone Loss after Hip Arthroplasty

Abstract: Prognostic Study, Level I (high quality prospective study-all patients were enrolled at the same point in their disease with > or = 80% followup of enrolled patients). See the Guidelines for Authors for a complete description of levels of evidence.

Cited by 6 publications

References 24 publications

The Effect of Weekly Risedronate on Periprosthetic Bone Resorption Following Total Hip Arthroplasty

The Effect of Weekly Risedronate on Periprosthetic Bone Resorption Following Total Hip Arthroplasty

Impact of trochanteric heterotopic ossification on measurement of femoral bone density following cemented total hip replacement

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

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