title: Decreased femoral periprosthetic bone mineral density: a comparative study using DXA in patients after cementless total hip arthroplasty with osteonecrosis of the femoral head versus primary osteoarthritis.
abstract: BACKGROUND
  Trabecular properties in osteonecrosis of the femoral head (ONFH) are altered for bone volume and structure in the femoral head and proximal femoral canal. We analysed the periprosthetic bone mineral density (BMD) as a correlate to bony ingrowth in patients with ONFH who received a cementless THA.
  
  
  METHODS
  We performed a matched-pair analysis of 100 patients with ONFH (n = 50) and primary osteoarthritis (n = 50) who received the same, unilateral cementless THA. We compared the periprosthetic BMD 5 years after surgery by means of dual energy X-ray absorptiometry (DXA) analysing the seven femoral regions of interest (ROIs) according to Gruen.
  
  
  RESULTS
  Within the ONFH group, significantly lower BMD values were found in the ROI 1 and 7 (p < 0.05). No statistically significant difference was found for ROIs 2-6.
  
  
  CONCLUSIONS
  An altered periprosthetic bone stock in the proximal femur in patients with prior ONFH might be a possible risk factor for premature loosening of the femoral stem in THA. Surgeons need to consider coating and fixation philosophy of cementless implants when choosing the right stem for patients with ONFH.
authors.affiliation: Department of Orthopedic Surgery, Regensburg University Medical Center, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany. benjamin.craiovan@ukr.de.
authors.forename: Benjamin
authors.identifier: http://orcid.org/0000-0002-7735-1197
authors.initials: B
authors.lastname: Craiovan
authors.affiliation: Department of Orthopedic Surgery, Regensburg University Medical Center, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Woerner
authors.affiliation: Department of Orthopedic Surgery, Regensburg University Medical Center, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Winkler
authors.affiliation: Department of Orthopedic Surgery, Regensburg University Medical Center, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany.
authors.forename: Hans-Robert
authors.initials: HR
authors.lastname: Springorum
authors.affiliation: Department of Orthopedic Surgery, Regensburg University Medical Center, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Grifka
authors.affiliation: Department of Orthopedic Surgery, Regensburg University Medical Center, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Renkawitz
authors.affiliation: Department of Orthopedic Surgery, Regensburg University Medical Center, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany.
authors.forename: Armin
authors.initials: A
authors.lastname: Keshmiri
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods*; D015519:Bone Density; D001851:Bone Diseases, Metabolic; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D005270:Femur Head / Q000601:surgery; D005271:Femur Head Necrosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005500:Follow-Up Studies; D006621:Hip Joint / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications
keywords: Bone mineral density; Dual energy X-ray absorptiometry; Osteonecrosis of the femoral head; Total hip arthroplasty