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Hayakawa K, Date H, Nojiri S, Kaneko Y, Shibata K, Fujita N. Prospective randomized study on the effect of concurrent bone filling of tibial peg holes in cementless total knee arthroplasty. Knee 2024; 50:18-26. [PMID: 39098086 DOI: 10.1016/j.knee.2024.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 06/24/2024] [Accepted: 07/09/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND In total knee arthroplasty (TKA), cementless fixation is initially weaker than cement fixation. This study aimed to examine whether filling the tibial peg holes with bone improves initial fixation strength in cementless TKA. METHODS This prospective, comparative study examined 88 joints in 66 patients randomized to the bone filling (48 joints) or conventional group (no bone filling; 40 joints). All patients underwent TKA with the NexGen® trabecular metal modular tibial component. In the bone filling group, resected cancellous bone was filled into the peg holes before insertion of the tibial component. We performed clinical and plain radiographic evaluations after the operation and measured bone mineral density (BMD) at five sites below the component at 1, 3, 6, and 12 months postoperatively. RESULTS Operative time and clinical evaluations were not significantly different. Plain radiography showed significant longitudinal thickening of the trabecula below the peg (P<0.05) and decreased occurrence of reactive lines (P=0.07) in the bone filling group compared with the conventional group. BMD was significantly higher in the bone filling group in the medial region below the peg at 1, 3, and 6 months and in the central region at 1 and 3 months (all P<0.05). CONCLUSIONS When using the NexGen trabecular metal modular tibial component, concurrent peg hole bone filling increases the initial component fixation strength. Possible effects on long-term stabilization warrant further study.
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Affiliation(s)
- Kazue Hayakawa
- Department of Orthopedic Surgery, Fujita Health University, Aichi, Japan.
| | - Hideki Date
- Department of Orthopedic Surgery, Fujita Health University, Aichi, Japan
| | - Sho Nojiri
- Department of Orthopedic Surgery, Fujita Health University, Aichi, Japan
| | - Yosuke Kaneko
- Department of Orthopedic Surgery, Fujita Health University, Aichi, Japan
| | - Kohei Shibata
- Department of Orthopedic Surgery, Fujita Health University, Aichi, Japan
| | - Nobuyuki Fujita
- Department of Orthopedic Surgery, Fujita Health University, Aichi, Japan
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Zhou H, Chen L, Su H, Gong Y, Chen G, Tong P. Factors influencing periprosthetic bone mineral density in total knee arthroplasty: a systematic review. Arch Orthop Trauma Surg 2024; 144:2273-2281. [PMID: 38615291 DOI: 10.1007/s00402-024-05308-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 03/24/2024] [Indexed: 04/15/2024]
Abstract
INTRODUCTION Following total knee arthroplasty (TKA), there is a significant decline in periprosthetic bone mineral density (BMD), potentially resulting in complications such as prosthetic loosening, periprosthetic fracture, and influencing the postoperative recovery. The objective of this study was to summarize the factors influencing periprosthetic BMD in TKA from existing studies. METHODS A comprehensive systematic search was performed in 4 databases: Pubmed, Embase, Web of Science, and Cochrane Library. The last search was carried out on October 12, 2023. We used the keywords ''total knee arthroplasty'', ''bone mineral density'' and each of them combined with ''tibia'' and ''femur'' to identify all relevant articles reporting about potential impact factors influencing the periprosthetic BMD in patients after TKA. RESULTS Out of 1391 articles, 22 published from 2001 to 2023 were included in this systematic review. Following eligibility screening, six significant categories affecting periprosthetic BMD were recognized: prosthesis type, design of stem, coating, body weight, cement, and peg distance. CONCLUSION Mobile-bearing prostheses, modular polyethylene design, short stems, cruciform stems, avoidance of bone cement, higher body mass index, titanium nitride coating, and a smaller medial peg distance could potentially benefit periprosthetic BMD. Comprehensive consideration of diverse factors influencing periprosthetic BMD before surgery and collaboration with post-operative drug therapy are essential. TRIAL REGISTRY The PROSPERO registration number is CRD42023472030.
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Affiliation(s)
- Haojing Zhou
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Lei Chen
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Hai Su
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yichen Gong
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Guoqian Chen
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang, China.
| | - Peijian Tong
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang, China.
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Zhao G, Luo J, Ma J, Wang J. Decreased stress shielding with poly-ether-ether-ketone tibial implant for total knee arthroplasty - A preliminary study using finite element analysis. Heliyon 2024; 10:e27204. [PMID: 38463834 PMCID: PMC10920710 DOI: 10.1016/j.heliyon.2024.e27204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 02/26/2024] [Accepted: 02/26/2024] [Indexed: 03/12/2024] Open
Abstract
In total knee arthroplasty (TKA), the mechanical mismatch between cobalt-chromium (CoCr) alloy tibial implant and bone has been implicated in stress shielding and subsequent implant failure and bone resorption. This study investigates the biomechanical advantages of poly-ether-ether-ketone (PEEK) tibial implant, which exhibit properties analogous to those of the surrounding bone. A finite element analysis (FEA) was employed to assess and compare the biomechanical performances of PEEK and CoCr tibial implants in patients with and without osteoporosis. Four FEA models were constructed with PEEK and CoCr alloy implants in normal and osteoporotic tibias. Based on previous literature and our clinical experience, stresses measurements were taken at 16 points on the tibial plateau and 8 points on the two surfaces which were 10 mm and 20 mm apart from the tibial plateau, with specific regions quantified for stress shielding. The results showed significant differences in stress distribution between PEEK and CoCr implants. The PEEK implants exhibited higher equivalent stresses on the tibial plateau in all models (normal bone: 0.22 ± 0.07 MPa vs. 0.13 ± 0.06 MPa, p < 0.01; osteoporotic bone: 0.39 ± 0.06 MPa vs. 0.17 ± 0.07 MPa, p < 0.01). In non-osteoporotic models, the mean equivalent stresses on proximal tibial surfaces were similarly elevated for PEEK implants (0.29 ± 0.13 MPa vs. 0.21 ± 0.08 MPa, p = 0.02). The CoCr implants demonstrated more stress shielding across all measured regions (tibial plateau: 23.47% vs. 2.73%; surface 1: 15.93% vs. 1.37%; surface 2: 10.71% vs. 6.56%). These disparities were even more pronounced in osteoporotic models in the CoCr group (tibial plateau: 32.50% vs. 8.36%). The maximum equivalent stresses on the tibial plateau further supported this trend (normal bone: 1.02 MPa vs. 0.52 MPa; osteoporotic bone: 1.43 MPa vs. 0.67 MPa). These data confirm the hypothesis that a PEEK tibial implant can reduce peri-prosthetic stress shielding, suggesting that PEEK implants have the capability to distribute loads more uniformly and maintain a closer approximation to physiological conditions.
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Affiliation(s)
- Guanghui Zhao
- Department of Joint Surgery, Honghui Hospital, Xi’An Jiaotong University, No.555 East Youyi Road, Xi'an, Shaanxi, China
| | - Jing Luo
- Department of Architecture, Xi’An University of Architecture and Technology, No.13 Yanta Road, Xi'an, Shaanxi, China
| | - Jianbing Ma
- Department of Joint Surgery, Honghui Hospital, Xi’An Jiaotong University, No.555 East Youyi Road, Xi'an, Shaanxi, China
| | - Jianpeng Wang
- Department of Joint Surgery, Honghui Hospital, Xi’An Jiaotong University, No.555 East Youyi Road, Xi'an, Shaanxi, China
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Çalbiyik M, Zehir S, Demirezen MO. Comparison of radiological and functional results in osteoporotic distal femur fractures operated with single plating, lateral incision, and double plating, anterior paramedial incision: A retrospective study. Medicine (Baltimore) 2024; 103:e36904. [PMID: 38306559 PMCID: PMC10843363 DOI: 10.1097/md.0000000000036904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/18/2023] [Indexed: 02/04/2024] Open
Abstract
Treatment of osteoporotic distal femur fractures is often complicated by a high rate of nonunion and varus collapse. For such fractures, lateral plating with lateral incision and double plating with anterior paramedial incision have shown promising results in the recent literature. The hypothesis of this study was that bilateral plating of comminuted distal femur fractures in osteoporotic patients would result in higher union rates and lower revision rates compared to an isolated lateral locking plate. The study included 56 patients (23 males, 33 females) with supracondylar femur fracture. According to the OA/OTA classification, 9 were type A3, 8 were A2, 13 were C1, 16 were C2, and 10 were C3. The mean follow-up period was 12 months, with 29 patients treated using lateral mini-incision, lateral locking plate, and 27 patients treated with anterior paramedial incision, dual plating. The clinical and radiological results were evaluated. The mean duration of radiological union in the studied population was 15 ± 2.1 months (range, 11-21 months) in the single plate group (Group A), and 13.5 ± 2.6 months (range, 9-19 months) in the double plate group (Group B). Mean ROM was 112.3° and flexion contracture 4° in Group A, and ROM 108.3° and flexion contracture 6.7° in Group B. (P = .15). The average Western Ontario and McMaster Universities Arthritis Index (WOMAC) score was 85.6 points in Group A and 83.5 points in Group B (P = .2278). The postoperative anteversion measurement in the operated extremity ranged from -15 to 19 in Group A, and from 5 to 18 in Group B. When the anteversion degrees were compared between the injured and uninjured extremities in the postoperative period, a significant difference was observed within Group A (P = .0018), but no significant difference was observed in Group B (P = .2492). Dual plate fixation using the anterior paramedial approach is an effective operative method for osteoporotic distal femur fractures. This has many advantages such as precise exposure, easy manipulation, anatomic reduction, and stable fixation. However, for surgical indications and medial bone defects > 1 cm, grafting should be performed.
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Affiliation(s)
- Murat Çalbiyik
- Hitit University, Faculty of Medicine, Department of Orthopedics and Traumatology, Corum, Turkey
| | - Sinan Zehir
- Hitit University, Faculty of Medicine, Department of Orthopedics and Traumatology, Corum, Turkey
| | - Murat Okan Demirezen
- Hitit University, Faculty of Medicine, Department of Orthopedics and Traumatology, Corum, Turkey
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[Research progress on the correlation between sarcopenia and osteoarthritis]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:1549-1557. [PMID: 36545865 PMCID: PMC9763072 DOI: 10.7507/1002-1892.202209015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective To review the research progress on the correlation between sarcopenia and osteoarthritis (OA). Methods The basic and clinical studies at home and abroad in recent years on sarcopenia and OA were extensively reviewed. The correlation between sarcopenia and OA was analyzed and summarized from five aspects: epidemiological status, risk factors, pathogenesis, clinical treatments, and the impact on joint arthroplasty. Results Sarcopenia and OA are common diseases in the elderly with high prevalence and can increase the ill risk of each other. They share a set of risk factors, and show negative interactive and influence on pathogenesis and clinical treatments, thus participating in each other's disease process and reducing the treatment benefits. Clinical studies show that sarcopenia can affect the rehabilitation effect and increase the risk of postoperative complications after total joint arthroplasty in many ways. Conclusion Current research results show that sarcopenia and OA are related and can be mutually affected in the above 5 aspects, but more studies are needed to further clarify the relationship between them, so as to provide more theoretical basis for the understanding, prevention, diagnosis, and treatments of the two diseases.
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Wilson JL, Squires M, McHugh M, Ahn J, Perdue A, Hake M. The geriatric distal femur fracture: nail, plate or both? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03337-5. [PMID: 35895117 DOI: 10.1007/s00590-022-03337-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/05/2022] [Indexed: 06/15/2023]
Abstract
Surgical fixation of distal femur fractures in geriatric patients is an evolving topic. Unlike hip fractures, treatment strategies for distal femur fractures are ill-defined and lack substantive high-quality evidence. With an increasing incidence and an association with significant morbidity and mortality, it is essential to understand existing treatment options and their supporting evidence. Current fixation methods include the use of either retrograde intramedullary nails, or plate and screw constructs. Due to the variability in fracture patterns, the unique anatomy of the distal femur, and the presence or absence or pre-existing implants, decision-making as to which method to use can be challenging. Recent literature has sought to describe the advantages and disadvantages of each, however, there is currently no consensus on a standard of care, and little randomized evidence is available that directly compares intramedullary nails with plating. Future randomized studies comparing intramedullary nails with plating constructs are necessary in order to develop a standard of care based on injury characteristics.
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Affiliation(s)
- Jenna L Wilson
- Orthopaedic Surgery Department, 1500 East Medical Center Drive, TC2912, SPC 5328, Ann Arbor, MI, 48109, USA.
| | - Mathieu Squires
- Orthopaedic Surgery Department, 1500 East Medical Center Drive, TC2912, SPC 5328, Ann Arbor, MI, 48109, USA
| | - Michael McHugh
- Orthopaedic Surgery Department, 1500 East Medical Center Drive, TC2912, SPC 5328, Ann Arbor, MI, 48109, USA
| | - Jaimo Ahn
- Orthopaedic Surgery Department, 1500 East Medical Center Drive, TC2912, SPC 5328, Ann Arbor, MI, 48109, USA
| | - Aaron Perdue
- Orthopaedic Surgery Department, 1500 East Medical Center Drive, TC2912, SPC 5328, Ann Arbor, MI, 48109, USA
| | - Mark Hake
- Orthopaedic Surgery Department, 1500 East Medical Center Drive, TC2912, SPC 5328, Ann Arbor, MI, 48109, USA
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He Z, Cai J, Wang X, Lu D. Clinical and Functional Outcomes of Total Knee Arthroplasty in Sarcopenia: A Case-Control Retrospective Cohort Study. J Knee Surg 2021; 36:631-636. [PMID: 34952547 DOI: 10.1055/s-0041-1740928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of the study was to investigate the relationship between sarcopenia and both clinical and functional outcome scores following total knee arthroplasty (TKA) performed for patients over 65 years of age. METHODS We assessed patient demographics, preoperative health status, postoperative Knee Society Clinical (KSS-C) and Function (KSS-F) subscores, and perioperative complications for 180 patients with sarcopenia and 345 comparatively healthy patients at a mean of 12.0 months after surgery. Multivariate logistic regression analysis was performed to define whether sarcopenia was an independent risk factor for lower KSS-F and KSS-C subscores and peroperative complication rates. Patients with sarcopenia had lower mean body mass index, preoperative albumin, and preoperative hemoglobin levels (p < 0.01). RESULTS Compared with the healthy control group, patients with sarcopenia had lower KSS-C (83.0 vs. 88.2, p < 0.01) and KSS-F (79.2 vs. 86.1, p < 0.01) subscores and increased postoperative complication rates (14.1% vs. 4.1%, p < 0.01). CONCLUSION Patients with sarcopenia present with generally poorer preoperative health and this appears to be associated with lower patient-reported clinical and functional outcome scores. Complication rates were higher among patients with sarcopenia who were still determined to have adequate health status to support TKA. Most complications were limited and could be managed with supportive treatment.
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Affiliation(s)
- Zili He
- Department of Orthopedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Jie Cai
- Department of Orthopedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Xingyu Wang
- Department of Orthopedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Di Lu
- Department of Orthopedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
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von Vopelius E, Oheim R, Amling M, Rolvien T, Beil FT. Skeletal characterization in a patient with Hajdu-Cheney syndrome undergoing total knee arthroplasty. Osteoporos Int 2021; 32:1899-1904. [PMID: 33742215 PMCID: PMC8387270 DOI: 10.1007/s00198-021-05914-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/05/2021] [Indexed: 11/19/2022]
Abstract
Hajdu-Cheney syndrome (HCS) is a rare genetic connective tissue disorder caused by gain-of-function mutations in the NOTCH2 gene. We report a 38-year-old male HCS patient with a history of multiple pathologic fractures, poor bone stock under intermittent antiresorptive therapy, and secondary osteoarthritis (OA) of the knee, in which we successfully performed total knee arthroplasty (TKA). Next to a detailed skeletal assessment including laboratory bone metabolism markers, dual energy X-ray absorptiometry (DXA), and high-resolution peripheral quantitative computed tomography (HR-pQCT), undecalcified histologic and histomorphometric analysis was performed on intraoperatively obtained tibial cut sections. This multiscale assessment revealed a severe, combined trabecular-cortical microarchitectural deterioration, increased bone turnover indices, and advanced cartilage degeneration, thus demonstrating the crucial role of Notch2 in skeletal and cartilage homeostasis, which is in line with the findings of previous mouse models.
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Affiliation(s)
- E von Vopelius
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - R Oheim
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- National Bone Board, Martin Zeitz Center for Rare Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Amling
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - T Rolvien
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - F T Beil
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
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Jacksteit R, Stöckel T, Behrens M, Feldhege F, Bergschmidt P, Bader R, Mittelmeier W, Skripitz R, Mau-Moeller A. Low-Load Unilateral and Bilateral Resistance Training to Restore Lower Limb Function in the Early Rehabilitation After Total Knee Arthroplasty: A Randomized Active-Controlled Clinical Trial. Front Med (Lausanne) 2021; 8:628021. [PMID: 34239883 PMCID: PMC8257942 DOI: 10.3389/fmed.2021.628021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 05/18/2021] [Indexed: 01/08/2023] Open
Abstract
Background: Continuous passive motion (CPM) is frequently used during rehabilitation following total knee arthroplasty (TKA). Low-load resistance training (LLRT) using continuous active motion (CAM) devices is a promising alternative. We investigated the effectiveness of CPM compared to LLRT using the affected leg (CAMuni) and both legs (CAMbi) in the early post-operative rehabilitation. Hypotheses: (I) LLRT (CAMuni and CAMbi) is superior to CPM, (II) additional training of the unaffected leg (CAMbi) is more effective than unilateral training (CAMuni). Materials and Methods: Eighty-five TKA patients were randomly assigned to three groups, respectively: (i) unilateral CPM of the operated leg; (ii) unilateral CAM of the operated leg (CAMuni); (iii) bilateral alternating CAM (CAMbi). Patients were assessed 1 day before TKA (pre-test), 1 day before discharge (post-test), and 3 months post-operatively (follow-up). Primary outcome: active knee flexion range of motion (ROMFlex). Secondary outcomes: active knee extension ROM (ROMExt), swelling, pain, C-reactive protein, quality of life (Qol), physical activity, timed-up-and-go performance, stair-climbing performance, quadriceps muscle strength. Analyses of covariances were performed (modified intention-to-treat and per-protocol). Results: Hypothesis I: Primary outcome: CAMbi resulted in a higher ROMFlex of 9.0° (95%CI −18.03–0.04°, d = 0.76) and 6.3° (95%CI −14.31–0.99°, d = 0.61) compared to CPM at post-test and follow-up, respectively. Secondary outcomes: At post-test, C-reactive protein was lower in both CAM groups compared with CPM. Knee pain was lower in CAMuni compared to CPM. Improved ROMExt, reduced swelling, better stair-climbing and timed-up-and-go performance were observed for CAMbi compared to CPM. At follow-up, both CAM groups reported higher Qol and CAMbi showed a better timed-up-and-go performance. Hypothesis II: Primary outcome: CAMbi resulted in a higher knee ROMFlex of 6.5° (95%CI −2.16–15.21°, d = 0.56) compared to CAMuni at post-test. Secondary outcomes: At post-test, improved ROMExt, reduced swelling, and better timed-up-and-go performance were observed in CAMbi compared to CAMuni. Conclusions: Additional LLRT of the unaffected leg (CAMbi) seems to be more effective for recovery of function than training of the affected leg only (CAMuni), which may be mediated by positive transfer effects from the unaffected to the affected limb (cross education) and/or preserved neuromuscular function of the trained, unaffected leg. Trial Registration:ClinicalTrials.gov Identifier: NCT02062138.
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Affiliation(s)
- Robert Jacksteit
- Department of Orthopaedics, University Medicine Rostock, Rostock, Germany
| | - Tino Stöckel
- Institute of Sport Science, University of Rostock, Rostock, Germany
| | - Martin Behrens
- Department of Orthopaedics, University Medicine Rostock, Rostock, Germany.,Department of Sport Science, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Frank Feldhege
- Institute of Sport Science, University of Rostock, Rostock, Germany
| | - Philipp Bergschmidt
- Department of Traumatology, Orthopaedics and Hand Surgery, Klinikum Südstadt, Rostock, Germany
| | - Rainer Bader
- Department of Orthopaedics, University Medicine Rostock, Rostock, Germany
| | | | - Ralf Skripitz
- Department of Orthopaedics, Roland Klinik, Bremen, Germany
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Wei W, Wu Y, Zeng Y, Shen B. [Progress of change in bone mineral density after knee arthroplasty]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:124-129. [PMID: 33448210 DOI: 10.7507/1002-1892.202006068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective To summarize research progress of change in bone mineral density (BMD) after knee arthroplasty and its diagnostic methods, influencing factors, and drug prevention and treatment. Methods The relevant literature at home and abroad was reviewed and summarized from research status of the advantages and disadvantages of BMD assessment methods, the trend of changes in BMD after knee arthroplasty and its influencing factors, and the differences in effectiveness of drugs. Results The central BMD and mean BMD around the prosthesis decrease after knee arthroplasty, which is closely associated with body position, age, weight, daily activities, and the fixation methods, design, and material of prosthesis. Denosumab, bisphosphonates, and teriparatide et al. can decrease BMD loss after knee arthroplasty. Conclusion BMD after knee arthroplasty decreases, which is related to various factors, but the mechanism is unclear. At present, some inhibitors of bone resorption can decrease BMD loss after knee arthroplasty. However, its long-term efficacy remains to be further explored.
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Affiliation(s)
- Wenxing Wei
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Yuangang Wu
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Yi Zeng
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Bin Shen
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
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Canton G, Giraldi G, Dussi M, Ratti C, Murena L. Osteoporotic distal femur fractures in the elderly: peculiarities and treatment strategies. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:25-32. [PMID: 31821280 PMCID: PMC7233703 DOI: 10.23750/abm.v90i12-s.8958] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 10/25/2019] [Indexed: 11/23/2022]
Abstract
Distal femur fractures account for 4-6% of osteoporosis related fractures of the femur in the elderly population. They represent a relevant cause of morbidity and mortality in the geriatric population with a reported 1-year mortality reaching 30%. Non-displaced fractures or even displaced fractures in patients with high operative risk can be treated conservatively. However, operative treatment is the most widely accepted management option for displaced fractures. The advantage resides in early mobilization and weight-bearing, reducing risks related with a prolonged immobilization when compared with conservative treatment. On the other hand, the intrinsic difficulty of fixing an osteoporotic bone is a major concern. The presence of osteosynthesis devices or prosthetic implants in the femur can make the surgical treatment more challenging, sometimes limiting therapeutic options. Aim of the present paper is to review the most recent literature about osteoporotic distal femur fractures in the elderly, including periprosthetic and other hardware related fractures, to highlight current evidence on management options and related results as a guide for the daily clinical practice.
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Affiliation(s)
- Gianluca Canton
- Orthopaedics and Traumatology Unit, Cattinara Hospital, Department of Medical, Surgical and Life Sciences, Trieste University, Trieste, Italy..
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Bernatz JT, Krueger DC, Squire MW, Illgen RL, Binkley NC, Anderson PA. Unrecognized Osteoporosis Is Common in Patients With a Well-Functioning Total Knee Arthroplasty. J Arthroplasty 2019; 34:2347-2350. [PMID: 31227302 DOI: 10.1016/j.arth.2019.05.041] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 05/05/2019] [Accepted: 05/22/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Peri-prosthetic fractures after total knee arthroplasty (TKA) are associated with poorer outcomes and high costs. We hypothesize that osteoporosis is under-recognized in the TKA population. The purpose of this study is to report osteoporosis prevalence in a healthy cohort of patients with well-functioning TKA and to compare prevalence between males and females. METHODS This study is a cross-sectional study of 30 adults (15 males/15 females) aged 59-80 years without known bone health issues who volunteered to undergo routine dual-energy X-ray absorptiometry 2-5 years (average 3.2 ± 0.8) after primary unilateral TKA. These data plus clinical risk factors were used to estimate fracture risk via the Fracture Risk Assessment Tool and skeletal status (normal, osteopenic, osteoporotic) was determined based on the World Health Organization definition. The National Osteoporosis Foundation criteria for treatment were applied to all patients. RESULTS Six of 30 (20%) patients had T-score ≤ -2.5. Eighteen of 30 (60%) patients had T-score between -1 and -2.5 and 6 (20%) patients had T-score ≥ -1. Five patients with normal or osteopenic bone mineral density (BMD) had occult vertebral fractures. Eleven of 30 (36.7%) patients met National Osteoporosis Foundation criteria for pharmacologic treatment. CONCLUSION The prevalence of occult osteoporosis meeting treatment guidelines after TKA is substantial in this sample (36.7%). BMD and osteoporosis prevalence are similar between men and women. This underappreciated prevalence of osteoporosis may contribute to peri-prosthetic fracture risk. Arthroplasty surgeons and bone health specialists must be aware of post-operative changes in bone density. These data support the further study of post-operative osteoporosis and consideration of routine BMD screening after TKA. LEVEL OF EVIDENCE III.
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Affiliation(s)
- James T Bernatz
- Department of Orthopedics & Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Diane C Krueger
- Osteoporosis Clinical Research Program, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Matthew W Squire
- Department of Orthopedics & Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Richard L Illgen
- Department of Orthopedics & Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Neil C Binkley
- Osteoporosis Clinical Research Program, University of Wisconsin School of Medicine and Public Health, Madison, WI; Department of Medicine, Division of Endocrinology and Geriatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Paul A Anderson
- Department of Orthopedics & Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, WI
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Prince JM, Bernatz JT, Binkley N, Abdel MP, Anderson PA. Changes in femoral bone mineral density after total knee arthroplasty: a systematic review and meta-analysis. Arch Osteoporos 2019; 14:23. [PMID: 30798359 DOI: 10.1007/s11657-019-0572-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 01/27/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Bone loss after total knee arthroplasty (TKA) may lead to periprosthetic fractures that are associated with significant costs (morbidity, economic, etc.) and pose a challenge to operative fixation. This meta-analysis quantifies the change in bone mineral density (BMD) of the distal femur after primary TKA. METHODS A systematic review of six databases was performed by two independent reviewers. Studies that reported bone density after knee arthroplasty were identified and inclusion/exclusion criteria was applied. Data were extracted and analyzed using the Comprehensive Meta-Analysis Software. RESULTS Fourteen studies were included in the analysis. The average decrease in BMD was 0.09 [0.05, 0.13], 0.14 [0.08, 0.20], 0.16 [0.10, 0.23], and 0.16 [0.12, 0.20] g/cm2 at 3, 6, 12, and 24 months, respectively, corresponding to a 9.3%, 13.2%, 15.8%, and 15.4% BMD loss. A high degree of heterogeneity existed between the studies (I2 > 90% at most time points). CONCLUSION In summary, there is a rapid and significant 15% decrease in BMD in the first 6 months after TKA that is sustained to 24 months. Better understanding regarding how perioperative optimization of bone health may affect BMD loss and the incidence of periprosthetic fracture is essential. LEVEL OF EVIDENCE Therapeutic Level II.
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Affiliation(s)
- Joel M Prince
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, UWMF Centennial Building, 1685 Highland Avenue, 6th Floor, Madison, WI, 53705, USA
| | - James T Bernatz
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, UWMF Centennial Building, 1685 Highland Avenue, 6th Floor, Madison, WI, 53705, USA
| | - Neil Binkley
- University of Wisconsin Osteoporosis Clinical Research Program, Madison, WI, 53705, USA
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 65905-53705, USA
| | - Paul A Anderson
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, UWMF Centennial Building, 1685 Highland Avenue, 6th Floor, Madison, WI, 53705, USA.
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14
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Blaty T, Krueger D, Illgen R, Squire M, Heiderscheit B, Binkley N, Anderson P. DXA evaluation of femoral bone mineral density and cortical width in patients with prior total knee arthroplasty. Osteoporos Int 2019; 30:383-390. [PMID: 30171301 DOI: 10.1007/s00198-018-4682-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 08/19/2018] [Indexed: 01/07/2023]
Abstract
UNLABELLED Periprosthetic fractures after total knee arthroplasty (TKA) have devastating consequences. Osteoporosis increases periprosthetic fracture risk, but distal femur bone mineral density (BMD) is not measured post-TKA. This study measured distal femur BMD and cortical width; both were lower in the TKA compared to the non-operated leg. BMD measurement reproducibility was good. Standardized DXA regions of interest are proposed. INTRODUCTION Periprosthetic fractures following total knee arthroplasty (TKA) are not rare. We hypothesized that TKA is associated with low BMD, potentially increasing periprosthetic fracture risk. However, distal femur dual energy x-ray (DXA) measurement is virtually never performed after TKA due to lack of standardized approaches. Thus, this study's aims were to develop standard DXA femur regions of interest (ROIs), assess cortical width, and determine measurement reproducibility in TKA patients. METHODS Thirty adults (15 M/15 F) age 59-80 years with unilateral, primary TKA within 2-5 years had femoral DXA scans performed in duplicate using a Lunar iDXA densitometer. In prior work, we established that femur BMD was lowest in the distal metaphysis and highest in mid-shaft. Thus, BMD and cortical width were measured at 15%, 25%, and 60% of the femur length measured from the distal notch. Femur BMD and cortical width were compared between limbs (TKA vs. non-operated side) by paired t test. RESULTS BMD was 3.2-9.9% lower (p < 0.001) in the operated femur at all custom ROIs; substantial between individual differences existed with some up to 30% lower. Cortical width was lower (p < 0.05) at the 25% ROI on the TKA side. BMD reproducibility was excellent; CV 0.85-1.33%. CONCLUSIONS Distal femur BMD can be reproducibly measured using DXA and is ~ 10% lower on the TKA leg. Similarly, medial and lateral cortices are thinner at the 25% ROI. These bone changes likely increase periprosthetic fracture risk. Further work to define and mitigate periprosthetic fracture risk after TKA is needed.
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Affiliation(s)
- T Blaty
- Osteoporosis Clinical Research Program, University of Wisconsin School of Medicine and Public Health, 2870 University Ave. Ste. 100, Madison, WI, 53705, USA
| | - D Krueger
- Osteoporosis Clinical Research Program, University of Wisconsin School of Medicine and Public Health, 2870 University Ave. Ste. 100, Madison, WI, 53705, USA
| | - R Illgen
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - M Squire
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - B Heiderscheit
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - N Binkley
- Osteoporosis Clinical Research Program, University of Wisconsin School of Medicine and Public Health, 2870 University Ave. Ste. 100, Madison, WI, 53705, USA.
| | - P Anderson
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Thomas B, Binkley N, Anderson PA, Krueger D. DXA Measured Distal Femur Bone Mineral Density in Patients After Total Knee Arthroplasty: Method Development and Reproducibility. J Clin Densitom 2019; 22:67-73. [PMID: 30228047 DOI: 10.1016/j.jocd.2018.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 08/07/2018] [Accepted: 08/07/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Total knee arthroplasty (TKA) is increasingly being performed. Distal femur periprosthetic fracture is a potentially catastrophic complication following TKA and existing data document substantial distal femur bone mineral density (BMD) loss following TKA. However, distal femur BMD is virtually never measured clinically as no consensus approach exists. This pilot study's purpose was to define regional BMD variation throughout the femur, suggest standard dual-energy X-ray absorptiometry (DXA) regions of interest (ROIs) and evaluate BMD reproducibility at these ROIs. METHODS Thirty volunteers 2-5 yr post TKA had both entire femurs imaged twice using a Lunar iDXA with subject repositioning between scans; the atypical femur fracture feature of enCORE software was utilized. To define femoral BMD distribution, custom 1 cm ROIs were stacked one atop the other starting at the intercondylar notch and continuing to the base of the lesser trochanter. Femur length was measured with the ruler tool to calculate distance at 5% increments. ROIs encompassing each 5% increment were utilized to measure BMD at each location. Descriptive statistics were used to determine mean BMD at each ROI and reproducibility at the 15%, 25%, 45%, 60%, and 80% ROIs. RESULTS The 5 and 10% ROIs included prosthetic and/or patella, causing high BMD values. Distal femur BMD was lowest at the 15% ROI and was higher (p < 0.05) at each more proximal ROI to 45%, then plateaued from 45% to 75%. BMD reproducibility at these regions was excellent; coefficient of variation (CV) from ∼1% to 3.5%. As periprosthetic fractures generally occur in the distal femur, we propose measuring femur BMD using ROIs placed at 15% and 25%. A 60% region could also be used as a highly cortical site. CONCLUSION Existing DXA capabilities allow distal femur BMD measurement with good reproducibility. Further research using standardized ROIs to assess distal femur BMD loss after TKA, and interventions to mitigate this loss, is indicated.
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Affiliation(s)
- B Thomas
- Osteoporosis Clinical Research Program, University of Wisconsin-Madison, Madison, WI, USA;.
| | - N Binkley
- Osteoporosis Clinical Research Program, University of Wisconsin-Madison, Madison, WI, USA
| | - P A Anderson
- Department of Orthopedic Surgery and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA
| | - D Krueger
- Osteoporosis Clinical Research Program, University of Wisconsin-Madison, Madison, WI, USA
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Cucchi D, Menon A, Galliera E, Messina C, Zanini B, Marazzi MG, Massaccesi L, Compagnoni R, Corsi Romanelli MM, Randelli P. A Prospective Assessment of Periprosthetic Bone Mineral Density and Osteoimmunological Biomarkers Variations After Total Knee Replacement Surgery. J Clin Densitom 2019; 22:86-95. [PMID: 30072203 DOI: 10.1016/j.jocd.2018.05.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 05/21/2018] [Accepted: 05/21/2018] [Indexed: 12/12/2022]
Abstract
Aseptic loosening is a major cause of premature failure of total knee replacement (TKR). Variations in periprosthetic bone mineral density (BMD) and osteoimmunological biomarkers levels could help to quantify prosthesis osteointegration and predict early aseptic loosening. The gene expression of 5 selected osteoimmunological biomarkers was evaluated in tibial plateau bone biopsies by real-time polymerase chain reaction and changes in their serum levels after TKR were prospectively evaluated with enzyme-linked immunosorbent assay for 1 yr after surgery. These variations were correlated to changes in periprosthetic BMD. Sixteen patients were evaluated. A statistically significant decrease in serum levels of Sclerostin (p = 0.0135) was observed immediately after surgery. A specular pattern was observed between dickkopf-related protein 1 and osteoprotegerin expression. No statistically significant changes were detectable in the other study biomarkers. Periprosthetic BMD did not change significantly across the duration of the follow-up. Prosthetic knee surgery has an impact on bone remodeling, in particular on sclerostin expression. Although not showing statistically significant changes, in the patterns of dickkopf-related protein 1, osteoprotegerin, and the ligand of the receptor activator of nuclear factor kappa-B symmetries and correspondences related to the biological activities of these proteins could be identified. Variation in osteoimmunological biomarkers after TKR surgery can help in quantifying prosthesis osteointegration.
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Affiliation(s)
- Davide Cucchi
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Bonn 53127, Germany; Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan 20133, Italy.
| | - Alessandra Menon
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan 20133, Italy; 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan 20122, Italy
| | - Emanuela Galliera
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan 20133, Italy; IRCCS Galeazzi Orthopaedic Institute, Milan 20161, Italy
| | - Carmelo Messina
- Department of Diagnostic and Interventional Radiology, IRCCS Galeazzi Orthopaedic Institute, Milan 20161, Italy
| | - Beatrice Zanini
- 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan 20122, Italy
| | - Monica Gioia Marazzi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan 20133, Italy
| | - Luca Massaccesi
- Department of Biomedical, Surgical and Oral Science, Università degli Studi di Milano, Milan 20133, Italy
| | - Riccardo Compagnoni
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan 20133, Italy; 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan 20122, Italy
| | - Massimiliano M Corsi Romanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan 20133, Italy; U.O.C SMEL-1 Patologia Clinica, IRCCS Policlinico San Donato, Milan 20097, Italy
| | - Pietro Randelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan 20133, Italy; 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan 20122, Italy
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Godziuk K, Prado CM, Woodhouse LJ, Forhan M. The impact of sarcopenic obesity on knee and hip osteoarthritis: a scoping review. BMC Musculoskelet Disord 2018; 19:271. [PMID: 30055599 PMCID: PMC6064616 DOI: 10.1186/s12891-018-2175-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 07/10/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The progressive, debilitating nature of knee and hip osteoarthritis can result in severe, persistent pain and disability, potentially leading to a need for total joint arthroplasty (TJA) in end-stage osteoarthritis. TJA in adults with obesity is associated with increased surgical risk and prolonged recovery, yet classifying obesity only using body mass index (BMI) precludes distinction of obesity phenotypes and their impact on surgical risk and recovery. The sarcopenic obesity phenotype, characterized by high adiposity and low skeletal muscle mass, is associated with higher infection rates, poorer function, and slower recovery after surgery in other clinical populations, but not thoroughly investigated in osteoarthritis. The rising prevalence and impact of this phenotype demands further attention in osteoarthritis treatment models of care, particularly as osteoarthritis-related pain, disability, and current treatment practices may inadvertently be influencing its development. METHODS A scoping review was used to examine the extent of evidence of sarcopenic obesity in adults with hip or knee osteoarthritis. Medline, CINAHL, Web of Science and EMBASE were systematically searched from inception to December 2017 with keywords and subject headings related to obesity, sarcopenia and osteoarthritis. RESULTS Eleven studies met inclusion criteria, with indications that muscle weakness, low skeletal muscle mass or sarcopenia are present alongside obesity in this population, potentially impacting therapeutic outcomes, and TJA surgical risk and recovery. CONCLUSIONS Consideration of sarcopenic obesity should be included in osteoarthritis patient assessments.
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Affiliation(s)
- Kristine Godziuk
- Faculty of Rehabilitation Medicine, University of Alberta, 8205 – 114 Street, 2-64 Corbett Hall, Edmonton, AB T6G 2G4 Canada
| | - Carla M. Prado
- Division of Human Nutrition, Faculty of Agricultural, Life and Environmental Sciences, University of Alberta, Edmonton, AB Canada
| | - Linda J. Woodhouse
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB Canada
| | - Mary Forhan
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB Canada
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Gundry M, Hopkins S, Knapp K. A Review on Bone Mineral Density Loss in Total Knee Replacements Leading to Increased Fracture Risk. Clin Rev Bone Miner Metab 2017; 15:162-174. [PMID: 29213219 PMCID: PMC5698368 DOI: 10.1007/s12018-017-9238-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The link between low bone mineral density (BMD) scores leading to greater fracture risk is well established in the literature; what is not fully understood is the impact of total knee replacements/revisions or arthroplasties on BMD levels. This literature review attempts to answer this question. Several different databases using specific key terms were searched, with additional papers retrieved via bibliographic review. Based on the available evidence, total knee replacements/revisions and arthroplasties lower BMD and thus increase fracture risk. This review also addresses the possible implications of this research and possible options to reduce this risk.
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Affiliation(s)
- M. Gundry
- University of Exeter Medical School, St Luke’s Campus, Heavitree Road, Exeter, EX1 2LU UK
| | - S. Hopkins
- University of Exeter Medical School, St Luke’s Campus, Heavitree Road, Exeter, EX1 2LU UK
| | - K. Knapp
- University of Exeter Medical School, St Luke’s Campus, Heavitree Road, Exeter, EX1 2LU UK
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SHIBUKI T, SUKEZAKI F, SUZUKI T, TOYOSHIMA Y, NAGAI T, INAGAKI K. Periprosthetic Bone Mineral Density Changes after Cementless Total Knee Arthroplasty. ACTA ACUST UNITED AC 2016. [DOI: 10.15369/sujms.28.155] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Takashi SHIBUKI
- Department of Orthopaedic Surgery, Showa University School of Medecine
| | - Fumio SUKEZAKI
- Department of Orthopaedic Surgery, Showa University School of Medecine
| | - Tastuya SUZUKI
- Department of Orthopaedic Surgery, Showa University School of Medecine
| | - Yoichi TOYOSHIMA
- Department of Orthopaedic Surgery, Showa University School of Medecine
| | - Takashi NAGAI
- Department of Orthopaedic Surgery, Showa University School of Medecine
| | - Katsunori INAGAKI
- Department of Orthopaedic Surgery, Showa University School of Medecine
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