Monitoring of Periprosthetic BMD After Uncemented Total Hip Arthroplasty with Dual-Energy X-Ray Absorptiometry—a 3-Year Follow-Up Study

Abstract

Insertion of a metallic implant into the femur changes bone loading conditions and results in remodeling of femoral bone. To quantify changes in bone mass after uncemented total hip arthroplasty (THA), we monitored femoral bone with dual-energy X-ray absorptiometry (DXA). The periprosthetic bone mineral density (BMD) was measured with Lunar DPX densitometry in seven Gruen zones and the total periprosthetic area at scheduled time intervals in 22 patients during a 3-year follow-up. BMD decreased significantly almost in all Gruen zones during the first 3 months, ranging from 3.4% to 14.4% (p < 0.05 to p < 0.001). At the end of the first year, the most remarkable decrease in BMD was found in the calcar (zone 7; ؊22.9%). During the second postoperative year, a slight restoration of periprosthetic bone mass was recorded. During the third year, no significant changes in BMD were found. The preoperative BMD was the only factor that was significantly related to the periprosthetic bone loss. Clearly, the early periprosthetic bone loss noticed during the 3 months after THA is caused by mainly limited weight bearing to the operated hip and stress shielding. We suggest that the restoration of bone mass is a sign of successful osteointegration between bone and metallic implant. DXA is a suitable tool to follow the bone response to prosthetization and will increase our knowledge on the behavior of bone after THA. (J Bone Miner Res 2001;16:1056 -1061)

Periprosthetic proximal bone loss after uncemented hip arthroplasty is related to stem size: DXA measurements in 138 patients followed for 2–7 years

“…Kilgus et al (1993) noted largest BMD loss (35%) in the most proximal 1 cm of the medial femoral cortex. Longitudinal studies have also been performed (Trevisan et al 1997, Venesmaa et al 2001, confirming the results of cross-sectional studies.…”

Bone Remodeling and Hydroxyapatite Resorption in Coated Primary Hip Prostheses

“…Augmented bone ongrowth has been documented as early as 3 weeks and as persisting for some years [2-4, 11, 26, 27]. However, as much as 20% to 30% of bone loss at the proximal femur has been reported after THA for the same period as a consequence of proximal stress shielding [8,21,30]. It also is expected and observed that the HA coating resorbs with time [1-3, 18, 19, 27, 28], although it is unknown whether this adversely influences the amount of long-term bone ongrowth.…”

“…Based on short-term bone density studies using dualenergy xray absorptiometry, gender and bone stock are believed to influence ongrowth and resorption [20,30]. Although age certainly is related to bone stock quality, a direct correlation between age and bone ongrowth onto implants such as uncemented HA-coated hip stems has not yet been proven.…”

Bone mineral density and biochemical markers of bone turnover in aseptic loosening after total hip arthroplasty

“…Regional bone loss has been studied widely using dual energy X-ray absorptiometry (DXA) [16,18], occurs around both the femoral and pelvic implant components [24], and is most rapid within the first six months after surgery [ 15,17,23,34]. Subjects with low pre-operative BMD show the greatest bone loss after THA [32], however it is unknown whether this results in a higher rate of aseptic loosening.…”