title: Larger femoral periprosthetic bone mineral density decrease following total hip arthroplasty for femoral neck fracture than for osteoarthritis: a prospective, observational cohort study.
abstract: Studies on patients with degenerative joint disease of the hip show that femoral periprosthetic bone mineral decreases following total hip arthroplasty. Scarcely any osteodensitometric data exist on femoral neck fracture (FNF) patients and periprosthetic bone remodelling. In two parallel cohorts we enrolled 87 patients (mean age, 72 ± 12 years; male:female ratio, 30:57) undergoing total hip arthroplasty for either primary osteoarthritis (OA) of the hip (n = 37) or for an acute FNF (n = 50) and followed them for a mean of 5.4 years. Outcomes were bone mineral density (BMD) changes in the periprosthetic Gruen zones 1-7, the incidence of periprosthetic fractures and clinical outcome. The bone mineral loss in the fracture group was more than twice that of the osteoarthritis group, -16.9% versus -6.8% (p = 0.004). The incidence of periprosthetic fractures was 12% (6/50) in the fracture cohort compared with none (0%) in the OA cohort (p = 0.03). Periprosthetic bone mineral loss following total hip arthroplasty is significantly greater in patients who are treated for acute FNF than in OA patients. This decrease of BMD follows a different pattern with the FNF patients losing larger proportions of bone in Gruen zones 1, 2, 6, and 7 while the OA patients tend to have larger losses only in zones 1 and 7.
authors: Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, New York.
authors: Tobias
authors: T
authors: Mann
authors: Thomas
authors: T
authors: Eisler
authors: Henrik
authors: H
authors: Bodén
authors: Olle
authors: O
authors: Muren
authors: André
authors: A
authors: Stark
authors: Mats
authors: M
authors: Salemyr
authors: Olof
authors: O
authors: Sköldenberg
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000706:statistics & numerical data*; D015519:Bone Density; D001862:Bone Resorption / Q000453:epidemiology* / Q000209:etiology; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005265:Femoral Neck Fractures / Q000628:therapy; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D015207:Osteoarthritis, Hip / Q000453:epidemiology* / Q000628:therapy; D057068:Periprosthetic Fractures / Q000453:epidemiology / Q000517:prevention & control; D011446:Prospective Studies; D011788:Quality of Life; D012086:Reoperation
keywords: bone mineral density; femoral neck fracture; osteoarthritis; periprosthetic fracture; total hip arthroplasty