Nam Denis, Barrack Robert L, Clohisy John C, Nunley Ryan M
Department of Orthopedic Surgery, Washington University School of Medicine/Barnes-Jewish Hospital, St. Louis, Missouri.
J Arthroplasty. 2016 Dec;31(12):2825-2830. doi: 10.1016/j.arth.2016.05.059. Epub 2016 Jun 3.
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.
接受髋关节置换术的年轻、活跃患者数量持续增加。本研究的目的是评估年轻、活跃患者髋关节置换术后5年期间的股骨骨密度。
前瞻性纳入96例患者（103髋），这些患者术前加利福尼亚大学洛杉矶分校（UCLA）症状前评分≥6，接受了全髋关节置换术（THA；45髋）或表面置换术（SRA；58髋）。术前和术后收集UCLA和Harris髋关节评分，并在术后6周、6个月、1年、2年和5年进行双能X线吸收测定扫描。对两组的7个传统Gruen区和SRA组的6个股骨颈区进行骨密度分析。计算骨密度与基线相比的变化率。
SRA组和THA组术前或术后的UCLA或Harris髋关节评分无差异（P = 0.07 - 0.7）。在THA组中，Gruen区1（基线的91.2%）、2（94.8%）、6（97.3%）和7（89.2%）的骨密度在5年期间从未恢复到基线水平。SRA组在任何时间间隔的股骨Gruen区骨密度变化率均无下降。SRA术后股骨颈骨密度在外侧、张力侧术后5年持续增加（P < 0.0001）。
采用非骨水泥股骨固定的年轻、活跃患者接受THA后，随着时间推移，Gruen区1、2和7的股骨近端骨密度降低。
