Parchi Paolo Domenico, Cervi Valentina, Piolanti Nicola, Ciapini Gianluca, Andreani Lorenzo, Castellini Iacopo, Poggetti Andrea, Lisanti Michele
1st Orthopedic Division, Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy.
Clin Cases Miner Bone Metab. 2014 Sep;11(3):226-31.
The application of Dual-energy X-ray absorptiometry (DEXA) in orthopaedic surgery gradually has been extended from the study of osteoporosis to different areas of interest like the study of the relation between bone and prosthetic implants. Aim of this review is to analyze changes that occur in periprosthetic bone after the implantation of a total hip arthroplasty (THA) or a total knee arthroplasty (TKA). In THA the pattern of adaptive bone remodeling with different cementless femoral stems varies and it appears to be strictly related to the design and more specifically to where the femoral stem is fixed on bone. Short stems with metaphyseal fixation allow the maintenance of a more physiologic load transfer to the proximal femur decreasing the entity of bone loss. Femoral bone loss after TKA seems to be related to the stress shielding induced by the implants while tibial bone remodeling seems to be related to postoperative changes in knee alignment (varus/valgus) and consequently in tibial load transfer. After both THA and TKA stress shielding seems to be an inevitable phenomenon that occurs mainly in the first year after surgery.
双能X线吸收法（DEXA）在骨科手术中的应用已逐渐从骨质疏松症的研究扩展到不同的感兴趣领域，如骨与假体植入物之间关系的研究。本综述的目的是分析全髋关节置换术（THA）或全膝关节置换术（TKA）植入后假体周围骨发生的变化。在THA中，不同非骨水泥型股骨干的适应性骨重塑模式各不相同，且似乎与设计密切相关，更具体地说，与股骨干在骨上的固定位置有关。采用干骺端固定的短柄假体能够维持向股骨近端更生理性的负荷传递，减少骨质流失。TKA后的股骨骨质流失似乎与植入物引起的应力遮挡有关，而胫骨骨重塑似乎与术后膝关节对线（内翻/外翻）的变化以及随之而来的胫骨负荷传递有关。在THA和TKA后，应力遮挡似乎都是一种不可避免的现象，主要发生在术后第一年。
