Modulation and Predictors of Periprosthetic Bone Mineral Density following Total Knee Arthroplasty

Abstract

Total knee arthroplasty (TKA) leads to a loss of periprosthetic bone mineral density (BMD). Great importance is attached to the prevention of periprosthetic bone loss with a view to ensuring a long service life of the prosthesis. In order to provide appropriate recommendations for preventive movement therapy measures to combat peri-implant bone loss, it is necessary to know the predictors of periprosthetic BMD. The aim of this study was (1) to determine the change of periprosthetic BMD of the femur and tibia and (2) to analyse the effects of different predictors on periprosthetic BMD. Twenty-three patients with primary TKA were evaluated 10 days and 3 months postoperatively. The data analysis comprised (1) the change in periprosthetic BMD from pretest to posttest and (2) the correlations between BMD and the variables isometric maximum voluntary force, lean mass, physical activity (step count), and BMI using multiple linear regression and structural equation modelling (SEM). BMD of the distal femur was significantly reduced by 19.7% (P = 0.008) 3 months after surgery, while no changes were found in BMD of the tibia. The results of SEM demonstrate that 55% of the BMD variance was explained by the model (χ2 = 0.002; df = 1; P = 0.96; χ2/df = 0.002; RMSEA < 0.01; TLI = 1.5; CFI = 1.0). A significant direct effect was only evidenced by the variable lean mass (β = 0.38; b = 0.15; SE = 0.07; C.R. = 2.0; P = 0.046). It can be assumed that a large muscle mass with accompanying distribution of high mechanical load in the bones can contribute to local changes of periprosthetic BMD. Concrete recommendations for preventing peri-implant bone loss therefore include exercises which have the aim of maintaining or building up muscle mass.

A Prospective Assessment of Periprosthetic Bone Mineral Density and Osteoimmunological Biomarkers Variations After Total Knee Replacement Surgery

“…The clinical outcome, ass quantified by the improvement in a functional score, was not associated with peri-prosthetic BMD change (11,12,25). A variable prosthesis-related stress-shielding and different patient's muscle mass could be possible explanations to these differences, as proposed Mau-Moeller et al after comparing DXA, muscle mass and strength ten days and three months after surgery in 23 patients undergoing TKA (26).…”

Skeletal characterization in a patient with Hajdu-Cheney syndrome undergoing total knee arthroplasty

“…In our HCS patient, the compromised bone status theoretically jeopardizes prosthetic osseointegration, substantiating cementation of the prosthesis at young age. In terms of preventive measures of peri-implant bone loss for patients undergoing TKA, moderate physical exercise can be recommended, as lean mass positively modulates periprosthetic BMD [ 16 ]. Finally, a close clinical and radiological follow-up should always be pursued in risk group patients undergoing orthopaedic surgical procedures.…”

Changes in femoral bone mineral density after total knee arthroplasty: a systematic review and meta-analysis

“…longitudinal study that reported the BMD of an area proximal to the superior border of the femoral components in 106 postmenopausal females. In a similarly designed study, Mau-Moeller et al [18] measured BMD three months postoperatively at the same femoral ROIs in 23 patients (65% male). Windisch et al [19] also measured supracondylar femur BMD prospectively in 50 patients at several time points in the first postoperative year.…”

“…Five of these studies were excluded as the absolute BMD could not be extracted. Details of the remaining studies included in the meta-analysis are shown in Table 1 (see Appendix for an in-depth summary of the studies) [10,[15][16][17][18][19][20][21][22][23][24][25][26][27]. Overall, BMD was reported for 547 patients on the operative side.…”