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

Alm JJ, Mäkinen TJ, Lankinen P, Moritz N, Vahlberg T, Aro HT - Acta Orthop (2009)

Bottom Line: 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.The other patient-related factors failed to show any association with the periprosthetic BMD changes.Systemic DXA screening for osteoporosis in postmenopausal patients before THA could be used to identify patients in need of prophylactic anti-resorptive therapy.

View Article: PubMed Central - PubMed

Affiliation: Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Turku University Central Hospital and University of Turku, Finland.

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.

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Gruen zones used in DXA analysis of periprosthetic BMD.
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Figure 0001: Gruen zones used in DXA analysis of periprosthetic BMD.

Mentions: DXA measurement of periprosthetic BMD was performed within 7 days of surgery (baseline) and the measurement was repeated at 3, 6, 12, and 24 months. During successive DXA scans, the patient's leg was positioned in a standard neutral rotation using a supporting device. Data were analyzed using software provided by the manufacturer (Metal Removal Option, Hologic). Periprosthetic BMD in the proximal femur was determined from 7 regions of interest (ROIs) (Figure 1) based on Gruen zones. BMD data of zones 1 through 7 were also combined to form a total periprosthetic BMD. The precision error of the Hologic DXA system was measured in 59 double scans performed at different follow-up time points. The precision error varied from 1.5% to 3.4% depending on the ROIs, with an average precision error of 2.3%, which is comparable to other studies (Venesmaa et al. 2001).


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

Alm JJ, Mäkinen TJ, Lankinen P, Moritz N, Vahlberg T, Aro HT - Acta Orthop (2009)

Gruen zones used in DXA analysis of periprosthetic BMD.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2823339&req=5

Figure 0001: Gruen zones used in DXA analysis of periprosthetic BMD.
Mentions: DXA measurement of periprosthetic BMD was performed within 7 days of surgery (baseline) and the measurement was repeated at 3, 6, 12, and 24 months. During successive DXA scans, the patient's leg was positioned in a standard neutral rotation using a supporting device. Data were analyzed using software provided by the manufacturer (Metal Removal Option, Hologic). Periprosthetic BMD in the proximal femur was determined from 7 regions of interest (ROIs) (Figure 1) based on Gruen zones. BMD data of zones 1 through 7 were also combined to form a total periprosthetic BMD. The precision error of the Hologic DXA system was measured in 59 double scans performed at different follow-up time points. The precision error varied from 1.5% to 3.4% depending on the ROIs, with an average precision error of 2.3%, which is comparable to other studies (Venesmaa et al. 2001).

Bottom Line: 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.The other patient-related factors failed to show any association with the periprosthetic BMD changes.Systemic DXA screening for osteoporosis in postmenopausal patients before THA could be used to identify patients in need of prophylactic anti-resorptive therapy.

View Article: PubMed Central - PubMed

Affiliation: Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Turku University Central Hospital and University of Turku, Finland.

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.

Show MeSH
Related in: MedlinePlus