title: Difference in periprosthetic acetabular bone mineral density: Prior total hip arthroplasty: Osteonecrosis of the femoral head versus primary osteoarthritis.
abstract: BACKGROUND
  Total hip arthroplasty (THA) could be associated with a higher failure rate in patients after osteonecrosis of the femoral head (ONFH) compared to a patient population with primary osteoarthritis prior THA, especially regarding the acetabular component. One major reason could be the compromised acetabular bone quality. Therefore, we performed a retrospective case matched study to assess: 1) Is there a difference in periprosthetic bone mineral density between patients with an ONFH prior THA and controls? 2) Do patients with an ONFH prior THA have a lower bone mineral density compared to controls? 3) Which region in the periprosthetic bone stock is more likely to present differences in periprosthetic bone mineral density between both groups?
  
  
  OBJECTIVE
  We hypothesized that there is a poorer bone mineral density (BMD) in the periacetabular bone stock in patients with an ONFH prior THA compared to controls receiving a THA due to primary osteoarthritis.
  
  
  METHODS
  We compared the BMD of 50 patients with ONFH to 50 controls with primary osteoarthritis prior THA using the same implant in mean 5 years after surgery by means of dual energy X-ray absorptiometry (DXA). We analysed 3 acetabular ROIs according to DeLee and Charnley in a modified measurement technique.
  
  
  RESULTS
  In ROI 3, representing acetabulum's upper aspect, statistically significant lower BMD values for the ONFH group could be found (P < 0.05). No difference was found for the modified ROIs 1 and 2 (respectively medial and lower acetabulum).
  
  
  CONCLUSIONS
  The results indicate a poorer periacetabular BMD in patients with ONFH prior THA, which might be responsible for premature loosening of the acetabular cup in THA. Due to a lack of literature, further clinical investigations are required to confirm our results.
  
  
  METHODS
  III: retrospective case-control study.
authors.affiliation: Department of Orthopaedic Surgery, University of Regensburg, Kaiser-Karl-V Allee 3, 93077 Bad Abbach, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Craiovan
authors.affiliation: Department of Orthopaedic Surgery, University of Regensburg, Kaiser-Karl-V Allee 3, 93077 Bad Abbach, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Wörner
authors.affiliation: Department of Orthopaedic Surgery, University of Regensburg, Kaiser-Karl-V Allee 3, 93077 Bad Abbach, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Maderbacher
authors.affiliation: Department of Orthopaedic Surgery, University of Regensburg, Kaiser-Karl-V Allee 3, 93077 Bad Abbach, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Grifka
authors.affiliation: Department of Orthopaedic Surgery, University of Regensburg, Kaiser-Karl-V Allee 3, 93077 Bad Abbach, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Renkawitz
authors.affiliation: Department of Orthopaedic Surgery, University of Regensburg, Kaiser-Karl-V Allee 3, 93077 Bad Abbach, Germany. Electronic address: keshmiri_armin@yahoo.de.
authors.forename: A
authors.initials: A
authors.lastname: Keshmiri
mesh_terms: D015502:Absorptiometry, Photon; D000077:Acetabulum / Q000000981:diagnostic imaging*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D015519:Bone Density; D016022:Case-Control Studies; D005260:Female; D005271:Femur Head Necrosis / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000601:surgery*; D012189:Retrospective Studies
keywords: Acetabular cup; Bone mineral density; Dual energy X-ray absorptiometry; Loosening; Osteonecrosis of the femoral head; Total hip arthroplasty