title: Proximal Femur Bone Density Decreases up to 5 Years After Total Hip Arthroplasty in Young, Active Patients.
abstract: The number of young, active patients undergoing hip arthroplasty continues to increase. The purpose of this study was to evaluate femoral bone density over a 5-year period after hip arthroplasty in young, active patients.
  
  
  
  A total of 96 patients (103 hips) with a presymptomatic University of California at Los Angeles (UCLA) score ≥6 who had a total hip arthroplasty (THA; 45 hips) or surface replacement arthroplasty (SRA; 58 hips) were prospectively enrolled. UCLA and Harris Hip Scores were collected preoperatively and postoperatively, and dual energy X-ray absorptiometry scans were performed at 6 weeks, 6 months, 1 year, 2 years, and 5 years postoperatively. Bone density was analyzed for 7 traditional Gruen zones in both groups and 6 femoral neck zones in the SRA group. Bone density ratios were calculated for change in bone density compared with baseline.
  
  
  
  No differences were present in the preoperative or postoperative UCLA or Harris Hip Scores between the SRA and THA cohorts (P = .07-.7). In the THA group, bone density never returned to baseline during the 5-year period in Gruen zones 1 (91.2% of baseline), 2 (94.8%), 6 (97.3%), and 7 (89.2%). There were no decreases in bone mineral density ratio for the femoral Gruen zones in the SRA group at any interval. Femoral neck bone density after SRA increased on the lateral, tension side up to 5 years postoperatively (P < .0001).
  
  
  
  Young, active patients undergoing THA with cementless femoral fixation demonstrate reductions in bone density in the proximal femur in Gruen zones 1, 2, and 7 over time.
authors.affiliation: Department of Orthopedic Surgery, Washington University School of Medicine/Barnes-Jewish Hospital, St. Louis, Missouri.
authors.forename: Denis
authors.initials: D
authors.lastname: Nam
authors.affiliation: Department of Orthopedic Surgery, Washington University School of Medicine/Barnes-Jewish Hospital, St. Louis, Missouri.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Barrack
authors.affiliation: Department of Orthopedic Surgery, Washington University School of Medicine/Barnes-Jewish Hospital, St. Louis, Missouri.
authors.forename: John C
authors.initials: JC
authors.lastname: Clohisy
authors.affiliation: Department of Orthopedic Surgery, Washington University School of Medicine/Barnes-Jewish Hospital, St. Louis, Missouri.
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Nunley
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D015519:Bone Density; D005260:Female; D005269:Femur / Q000601:surgery*; D005272:Femur Neck / Q000601:surgery*; D005500:Follow-Up Studies; D006621:Hip Joint / Q000601:surgery; D006622:Hip Prosthesis; D006801:Humans; D015141:Los Angeles; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011446:Prospective Studies; D012720:Severity of Illness Index; D055815:Young Adult
keywords: activity level; bone density; hip arthroplasty; surface replacement arthroplasty; total hip arthroplasty