Female patients with low systemic BMD are prone to bone loss in Gruen zone 7 after cementless total hip arthroplasty

Jessica J Alm, Tatu J Mäkinen, Petteri Lankinen, Niko Moritz, Tero Vahlberg, Hannu T Aro, Jessica J Alm, Tatu J Mäkinen, Petteri Lankinen, Niko Moritz, Tero Vahlberg, Hannu T Aro

Abstract

Background and purpose: Factors that lead to periprosthetic bone loss following total hip arthroplasty (THA) may not only depend on biomechanical implant-related factors, but also on various patient-related factors. We investigated the association between early changes in periprosthetic bone mineral density (BMD) and patient-related factors.

Patients and methods: 39 female patients underwent cementless THA (ABG II) with ceramic-ceramic bearing surfaces. Periprosthetic BMD in the proximal femur was determined with DXA after surgery and at 3, 6, 12, and 24 months. 27 patient-related factors were analyzed for their value in prediction of periprosthetic bone loss.

Results: Total periprosthetic BMD was temporarily reduced by 3.7% at 3 months (p < 0.001), by 3.8% at 6 months (p < 0.01), and by 2.6% at 12 months (p < 0.01), but recovered thereafter up to 24 months. Preoperative systemic osteopenia and osteoporosis, but not the local BMD of the operated hip, was predictive of bone loss in Gruen zone 7 (p = 0.04), which was the only region with a statistically significant decrease in BMD (23%, p < 0.001) at 24 months. Preoperative serum markers of bone turnover predicted the early temporary changes of periprosthetic BMD. The other patient-related factors failed to show any association with the periprosthetic BMD changes.

Interpretation: Female patients with low systemic BMD show greater bone loss in Gruen zone 7 after cementless THA than patients with normal BMD. Systemic DXA screening for osteoporosis in postmenopausal patients before THA could be used to identify patients in need of prophylactic anti-resorptive therapy.

Figures

Figure 1.
Figure 1.
Gruen zones used in DXA analysis of periprosthetic BMD.
Figure 2.
Figure 2.
An ABG II hip prosthesis postoperatively (a) and at 24 months (b). Bone loss in Gruen zone 7 was seen as rounding off of the medial femoral neck (shown with circle).
Figure 3.
Figure 3.
Change in BMD in Gruen zone 7 in THA patients with normal or low systemic BMD, as a function of healing time. In all groups, bone loss in this zone was statistically significant at 24 months (p

Figure 4.

Linear regression (with 95% confidence…

Figure 4.

Linear regression (with 95% confidence intervals) demonstrating the association (R 2 = 0.147,…

Figure 4.
Linear regression (with 95% confidence intervals) demonstrating the association (R2 = 0.147, R = 0.38, p = 0.015) between preoperative systemic BMD (lowest preoperative T-score) and change in periprosthetic femur BMD (in Gruen zone 7) at 24 months after THA (n = 36).
Figure 4.
Figure 4.
Linear regression (with 95% confidence intervals) demonstrating the association (R2 = 0.147, R = 0.38, p = 0.015) between preoperative systemic BMD (lowest preoperative T-score) and change in periprosthetic femur BMD (in Gruen zone 7) at 24 months after THA (n = 36).

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