全膝关节置换术和假体周围股骨远端骨折：超越骨质疏松症看既往骨质疏松性骨折。

Total knee arthroplasty and periprosthetic distal femoral fracture: looking beyond the osteoporosis to previous osteoporotic fracture.

机构信息

Department of Orthopedic Surgery, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, 110, Deokan-ro, Gwangmyeong-si, Gyeonggi-do, 14353, Republic of Korea.

Department of Orthopedic Surgery, Keunhim Hospital, 246, Sincheon-daero, Busanjin-gu, Busan, 47192, Republic of Korea.

出版信息

Osteoporos Int. 2024 Aug;35(8):1469-1475. doi: 10.1007/s00198-024-07138-w. Epub 2024 May 27.

DOI:10.1007/s00198-024-07138-w

PMID:38801524

Abstract

UNLABELLED

Osteoporosis increases the risk of periprosthetic distal femoral fractures after TKA, especially in patients with a history of osteoporotic fractures. Therefore, careful assessment and proper treatment of osteoporosis need and the importance of taking osteoporotic medication needs to be recognized by the patients following primary TKA.

PURPOSE

Osteoporosis is a risk factor for fractures, including those of the hip, vertebrae, and distal radius; however, the association between osteoporosis and periprosthetic fractures after total knee arthroplasty (TKA) has not been much investigated. Therefore, we aimed to investigate the association of the presence of systemic osteoporosis with periprosthetic fractures after TKA.

METHODS

This study included 34 patients with periprosthetic fractures following primary TKA and 106 controls matched for age and sex. Bone mineral density was evaluated at the femoral neck, total hip, and lumbar spine using dual X-ray absorptiometry. Medical records were reviewed for age; sex; body mass index; smoking; rheumatoid arthritis, endocrine diseases, and cardiovascular diseases; history of glucocorticoid use; medication for osteoporosis; and history of previous osteoporotic fracture. In addition, anterior femoral notching after TKA was evaluated. Univariable and multivariable logistic regression analysis were used to determine factors associated with periprosthetic fracture.

RESULTS

The prevalence of osteoporosis in the fracture group was higher than that in the control group (61.8% vs. 40.6%, p=0.045). The rate of medication for osteoporosis was significantly low in the fracture group (47.6 % vs 76.7%, p=0.026). History of previous osteoporotic fracture (odds ratio [OR], 9.1; p=0.015) and osteoporosis (OR, 3.6; p=0.013) were significant risk factors for periprosthetic fractures after TKA. Medication for osteoporosis could decrease the risk of periprosthetic fracture (OR 0.3; p=0.020).

CONCLUSION

Osteoporosis is a major risk factor for periprosthetic distal femoral fractures after TKA. Therefore, careful assessment and proper treatment of osteoporosis need and the importance of taking osteoporotic medication needs to be recognized to the patients following primary TKA, especially in patients with a history of osteoporotic fracture.

LEVEL OF EVIDENCE

Prognostic study, level III.

摘要

不具名

骨质疏松症会增加 TKA 后股骨假体周围远端骨折的风险，尤其是在有骨质疏松性骨折病史的患者中。因此，初次 TKA 后患者需要对骨质疏松症进行仔细评估和适当治疗，并认识到服用骨质疏松症药物的重要性。

目的

骨质疏松症是骨折的一个风险因素，包括髋部、椎体和桡骨远端骨折；然而，骨质疏松症与全膝关节置换术后（TKA）假体周围骨折之间的关系尚未得到广泛研究。因此，我们旨在研究系统性骨质疏松症与初次 TKA 后假体周围骨折之间的关系。

方法

本研究纳入了 34 例初次 TKA 后发生假体周围骨折的患者和 106 例年龄和性别匹配的对照患者。使用双能 X 线吸收仪评估股骨颈、全髋关节和腰椎的骨密度。回顾病历以获取年龄、性别、体重指数、吸烟史、类风湿关节炎、内分泌疾病和心血管疾病、糖皮质激素使用史、骨质疏松症药物治疗情况和既往骨质疏松性骨折史。此外，还评估了 TKA 后的股骨前切迹。采用单变量和多变量逻辑回归分析确定与假体周围骨折相关的因素。

结果

骨折组骨质疏松症的患病率高于对照组（61.8%比 40.6%，p=0.045）。骨折组服用骨质疏松症药物的比例明显较低（47.6%比 76.7%，p=0.026）。既往骨质疏松性骨折史（比值比[OR]，9.1；p=0.015）和骨质疏松症（OR，3.6；p=0.013）是 TKA 后假体周围骨折的显著危险因素。服用骨质疏松症药物可降低假体周围骨折的风险（OR，0.3；p=0.020）。