Fu Guangtao, Ma Yuanchen, Liao Junxing, Xue Yunlian, Li Mengyuan, Li Qingtian, Deng Zhantao, Zheng Qiujian
Division of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106, Zhongshaner Road, Yuexiu District, Guangzhou, Guangdong Province, People's Republic of China.
Division of Statistics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, People's Republic of China.
Arthroplasty. 2020 Jan 23;2(1):2. doi: 10.1186/s42836-020-0023-3.
Total hip arthroplasty is the most common orthopaedic procedure for the end-stage hip diseases. Periprosthetic bone loss is closely related to the increased risk of implant loosening and periprosthetic fractures, but the predictive value of periprosthetic bone mineral density (BMD) measured immediately after surgery has not yet been investigated.
From April 2015 to October 2017, 64 patients with femoral neck fracture, hip osteoarthritis, femoral head necrosis, or developmental dysplasia of the hip underwent unilateral total hip arthroplasty. Demographic data, bone mineral density of the hip and spine, periprosthetic BMD of 7 Gruen zones, and radiographic parameters measured preoperatively, 1 week, 3 months, and 12 months after surgery were collected. A p value < 0.05 was considered to be statistically significant.
Significant decreases of the periprosthetic BMD were found in Gruen zone 1 (- 8.0%; p < 0.05), Gruen zone 2 (- 6.3%; p < 0.05), Gruen zone 7 (- 8.6%; p < 0.05), and total Gruen zone (- 4.7%; p < 0.05) in the first postoperative year, compared with the values measured 1 week after surgery. The relationship between the preoperative BMD of the hip/spine and the BMD of Gruen zone 1 and Gruen zone 7 measured 1 week after surgery did not reach statistical significance. The multiple linear regression analysis illustrated that the bone loss in Gruen zone 7 at the end of the follow-up period was negatively affected (β = - 0.703) by the BMD of Gruen zone 7 measured 1 week after surgery, with a R of 0.486 (p < 0.05). Similar results were also found in Gruen zone 1 (β = - 0.448, R = 0.186; p < 0.05).
There were marked decreases in periprosthetic BMD of the proximal femur in the first postoperative year. The predictive values of preoperative BMD of hip and spine on periprosthetic bone loss after THA were limited. Higher periprosthetic BMD measured in immediate postoperative period may not guarantee less periprosthetic bone loss in the proximal femur after cementless THA.
全髋关节置换术是终末期髋关节疾病最常见的骨科手术。假体周围骨丢失与植入物松动和假体周围骨折风险增加密切相关，但术后立即测量的假体周围骨密度（BMD）的预测价值尚未得到研究。
2015年4月至2017年10月，64例股骨颈骨折、髋关节骨关节炎、股骨头坏死或髋关节发育不良患者接受了单侧全髋关节置换术。收集患者的人口统计学数据、髋部和脊柱的骨密度、7个Gruen分区的假体周围骨密度以及术前、术后1周、3个月和12个月测量的影像学参数。p值<0.05被认为具有统计学意义。
与术后1周测量的值相比，术后第1年Gruen分区1（-8.0%；p<0.05）、Gruen分区2（-6.3%；p<0.05）、Gruen分区7（-8.6%；p<0.05）和整个Gruen分区（-4.7%；p<0.05）的假体周围骨密度显著降低。术前髋部/脊柱骨密度与术后1周测量的Gruen分区1和Gruen分区7骨密度之间的关系未达到统计学意义。多元线性回归分析表明，随访期末Gruen分区7的骨丢失受到术后1周测量的Gruen分区7骨密度的负面影响（β=-0.703），R为0.486（p<0.05）。Gruen分区1也发现了类似结果（β=-0.448，R=0.186；p<0.05）。
术后第1年股骨近端假体周围骨密度显著降低。THA术后髋部和脊柱术前骨密度对假体周围骨丢失的预测价值有限。非骨水泥型THA术后立即测量的较高假体周围骨密度可能无法保证股骨近端假体周围骨丢失较少。
