Changes in tibial bone density measured from standard radiographs in cemented and uncemented total knee replacements after ten years’ follow-up

Abstract

Stress shielding resulting in diminished bone density following total knee replacement (TKR) may increase the risk of migration and loosening of the prosthesis. This retrospective study was designed to quantify the effects of the method of fixation on peri-prosthetic tibial bone density beneath cemented and uncemented tibial components of similar design and with similar long-term survival rates. Standard radiographs taken between two months and 15 years post-operatively were digitised from a matched group of TKRs using cemented (n = 67) and uncemented (n = 67) AGC tibial prostheses. Digital radiograph densitometry was used to quantify changes in bone density over time. Age, length of follow-up, gender, body mass index and alignment each significantly influenced the long-term pattern of peri-prosthetic bone density. Similar long-term changes in density irrespective of the method of fixation correlated well with the high rate of survival of this TKR at 20 years, and suggest that cemented and uncemented fixation are both equally viable.

Periprosthetic Bone Mineral Density Changes after Cementless Total Knee Arthroplasty

“…In our study, no signi cant bone reduction in the proximal medial tibia was observed at 24 months after surgery, suggesting that the BMD is stable in this area. However, decreases in BMD of the proximal tibia have been reported to persist even at 10 years following surgery 20 . Although correction of FTA changes the load-bearing axis of the leg and causes stress shielding, it is unclear when stress shielding ends.…”

Effect of activity level after TKA on the relative bone mineral density measured on standard radiographs in periprosthetic tibial bone: a five-year follow-up study

“…An increasing number of patients with end-stage osteoarthritis are receiving treatment with total knee arthroplasty (TKA), which is a successful procedure for alleviating pain, improving functional ability, and enhancing quality of life [1]. Bone mineral density (BMD) is an indicator of bone quality and re ects the material properties, bone metabolism and risk of fracture [2,3]. Postoperative changes in the periprosthetic bone density in the tibia are closely related to the outcomes of TKA.…”

“…Dual X-ray absorptiometry (DXA) is the gold standard clinical method used to evaluate BMD, but it is not used in routine examinations after TKA due to not only the absence of this technology in many hospitals with limited resources but also the high cost of the technology. Several studies have reported that the grayscale values measured on standard radiographs are closely related to BMD and can re ect changes in BMD [2,8]. Hernandez-Vaquero et al [8] revealed a method based on digital radiological densitometry to evaluate bone density using X-ray images.…”

Comparative evaluation of densitometry values through osteotropic therapy for the knee arthroplasty

“…Среди всех причин ревизионных опе-раций на долю асептического расшатывания имплан-тата приходится от 60 % до 73,8 % [2,10]. Развитие столь раннего остеолиза после замены сустава на ис-кусственный некоторые авторы связывают с наличием недостаточной физиологической нагрузки на поражен-ный коленный сустав вследствие имеющихся сгиба-тельных контрактур и приема нестероидных противо-воспалительных средств, оказывающих тормозящее влияние на функцию остеобластов [3,5,11].…”