The Importance of Bone Mineral Density in Hip Arthroplasty: Results of a Survey Asking Orthopaedic Surgeons about Their Opinions and Attitudes Concerning Osteoporosis and Hip Arthroplasty

Abstract

Objective. In patients scheduled to undergo total joint arthroplasty of the hip, the bone quality around the joint affects the safety of prosthetic implantation. Bone strength is clinically assessed by measuring bone mineral density (BMD); therefore we asked if BMD is important to orthopaedic surgeons performing hip arthroplasty. Methods. In a 14-question survey, we asked about treatment patterns with respect to BMD, osteoporosis work-up, and treatment for patients with low BMD scheduled to undergo hip arthroplasty. Results. 72% of all asked orthopaedics reported to use cementless implants as a standard in hip arthroplasty. Over 60% reported that low BMD is a reason to reconsider operation strategies, but only 4% performed BMD measurement preoperatively. 26% would change their treatment strategy in case of a BMD (T-Score) between −1.5 and −2 and 40% in case of a T-score between −2 and −2.5, and 29% would change their intraoperative strategy if a T-score smaller than −2.5 was measured. Conclusion. The majority of orthopaedic surgeons who responded to the survey reported that they do not perform routine measurement of BMD before arthroplasty. However, most surgeons commented that low bone mineral density will influence their surgical plan and the implant design.

A Review on Bone Mineral Density Loss in Total Knee Replacements Leading to Increased Fracture Risk

“…As such, it is suggested that patients with low BMD should be treated in order to combat this either through antiresorptive therapies, anabolic treatments or particular specialised implants prior to surgery in order to reduce this risk. The influence of low BMD does not only affect the patient; 60% of orthopaedic surgeons have stated that low BMD would influence their surgical plan and the implant design, yet only 4% performed BMD measurements preoperatively [ 124 ]. This is suggested by other research and states that surgeons must consider BMD loss if they are relying on bone for long-term stable fixation of the prosthesis [ 70 ].…”

Importance of Routine Bone Mineral Density Screening Prior to Elective Total Joint Replacement

“…The low rate of BMD screening found in the authors' patient population is consistent with national trends for BMD screening in primary care settings and available data suggesting that BMD screening is rarely performed prior to TJR. 20,22 One reason for low BMD screening rates prior to TJR is that orthopedic surgeons may not view this information as important to their clinical decision making or relevant to TJR outcomes. In a survey completed by 433 members of national and international orthopedic associations, only 4% stated that they routinely test BMD prior to performing THA.…”

“…In a survey completed by 433 members of national and international orthopedic associations, only 4% stated that they routinely test BMD prior to performing THA. 22 Interestingly, among the surgeons who responded that they do not routinely order BMD screening, 65% acknowledged that low BMD would be a reason to reconsider their choice of implant. In another survey of orthopedic surgeons, only 14% agreed that it is their responsibility to initiate osteoporosis follow-up after a patient sustains a minimal trauma fracture despite more than 80% acknowledging that discussing osteoporosis with a patient following a minimal trauma fracture may improve patient compliance with management.…”

“…23 These findings suggest that a significant proportion of orthopedic surgeons may be unaware of the clinical relevance of BMD screening and that most orthopedic surgeons do not view BMD screening as their responsibility, generally perceiving nonsurgical management of osteopenia/osteoporosis to be outside of their purview. [22][23][24][25] Orthopedic guidelines largely do not address the importance of conducting BMD screening prior to performing TJR and the potential for bisphosphonates to improve outcomes in TJR patients. The American Academy of Orthopaedic Surgeons guidelines for the surgical management of knee osteoarthritis and the American Academy of Orthopaedic Surgeons guidelines for the management of hip osteoarthritis offer no recommendations regarding BMD screening for patients who may be candidates for TJR.…”

Letter to the Editor on “Choices, Compromises, and Controversies in Total Knee and Total Hip Arthroplasty Modifiable Risk Factors: What You Need to Know”

“…For example, at the 2018 American Orthopedic Association Annual Meeting, 75% of orthopedic surgeons reported that they consider osteoporosis when deciding surgical technique, while at the same time only 5% actually measure bone density [8]. A report of European Surgeons is similar [9].…”