scholarly journals The Lasting Effect of Discontinuing Zoledronic Acid On Periprosthetic Bone Mineral Density Five Years After Total Hip Arthroplasty

2021 ◽  
Author(s):  
Allen Herng Shouh Hsu ◽  
Chun-Hsien Yen ◽  
Yu-Der Lu ◽  
Feng-Chih Kuo ◽  
Cheng-Ta Wu ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Renal Function ◽  
Zoledronic Acid ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Control Group ◽  
Mineral Density ◽  
Short Term ◽  
Periprosthetic Bone ◽  
Lasting Effect

Abstract Background: Previous study has shown that a short-term use of zoledronic acid (ZA) after cementless total hip arthroplasty (THA) significantly increases bone mineral density (BMD) over the proximal femur and inhibits bone turnover markers (BTMs) after two years. However, could the discontinuation of ZA have a lasting effect is of interest.Method: This is an extension study of a two-year prospective randomized controlled trial on 54 cementless THA treated with either two doses of ZA or placebo. We compared BTMs [alkaline phosphatase (ALP); osteocalcin (OC); procollagen 1 intact N-terminal propeptide (P1NP)], serum calcium, renal function, radiological findings, and functional outcomes (Harris hip score and UCLA activity score) from baseline to 5 years post-THA in 49 patients, and periprosthetic BMD of the seven Gruen zones in 19 patients.Result: All patients had well-functioning hip prostheses, normal renal function, and normal serum calcium levels at 5-year follow-up. At the fifth year, the BMD levels were not statistically different between the two groups, but the change in BMD from baseline (BMD change ratios) in ZA group were significantly increased in zone 2, 4, and 6 as compared with control group. Parallel to that, in ZA group, levels of ALP were significantly lower at the fifth year; OC were significantly lower at the second and the fifth year; P1NP were significantly lower from 6 weeks to 2 years as compared with those in control group.Conclusion: This study demonstrates the lasting effect of a two-dose ZA given within one year after THA on bone metabolism and periprosthetic BMD at five years. The short-term dosing of ZA followed by a 4-year drug holiday had no adverse events and resulted in significant inhibition of periprosthetic bone loss and BTMs.Trial Registration:This extension study on a randomized, open label, single-center clinical trial was conducted under Institutional Review Board of Chang Gung Memorial Hospital Protocol Records 98-1150A3; 105-1296C1; 105-7004D, and was registered July 19th, 2016 on public registry ClinicalTrials.gov trial registration number NCT02838121.

scholarly journals Preventing Loss of Femoral Periprosthetic Bone Mineral Density in Cementless Total Hip Arthroplasty Using a Tapered Wedge Stem in Patients With Osteoporosis Treated With Denosumab: a Retrospective, Cohort Study

2021 ◽  
Author(s):  
Keiji Kamo ◽  
Hiroaki Kijima ◽  
Koichiro Okuyama ◽  
Tetsuya Kawano ◽  
Nobutoshi Seki ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Total Hip Arthroplasty ◽  
Bone Mineral ◽  
Hip Arthroplasty ◽  
Stress Shielding ◽  
Control Group ◽  
Mineral Density ◽  
Total Hip ◽  
Cementless Total Hip Arthroplasty ◽  
Periprosthetic Bone Mineral Density

Abstract Background: Bone mineral density (BMD) of the proximal femur around the stem decreases due to stress shielding after cementless total hip arthroplasty (THA). When severe stress shielding occurs, the risk of periprosthetic femoral fractures increases, and this bone loss can also increase the difficulty of future revision THA. Denosumab is known to improve the quality and strength of cortical bone in the proximal femurs of patients with osteoporosis. The purpose of this study was to investigate whether denosumab prevents loss of proximal femoral periprosthetic BMD in cementless THA using a tapered wedge stem in patients with osteoporosis.Methods: Sixty-three consecutive patients who had undergone unilateral primary THA using a tapered wedge stem were included in this retrospective study. Twenty-four patients who received denosumab for osteoporosis were the denosumab group, and the 39 without denosumab were the control group. At 2 weeks, 6 months, and 12 months after THA, bone turnover markers and femoral periprosthetic BMD were measured.Results: BMD in zone 1 was significantly increased from baseline at both 6 and 12 months after THA in the denosumab group and significantly decreased in the control group. BMD in zone 7 was significantly decreased compared to baseline at both 6 and 12 months after THA in the control group, but not in the denosumab group. The use of denosumab for THA patients with osteoporosis was independently related to preventing loss of periprosthetic BMD of the femur at 12 months after surgery in zones 1 and 7 on multivariate analysis.Conclusions: Denosumab significantly increased proximal femoral periprosthetic BMD in zone 1 and prevented loss of BMD in zone 7 in patients with osteoporosis after cementless THA using a tapered wedge stem at both 6 and 12 months after surgery.

scholarly journals Short to Midterm Follow-Up of Periprosthetic Bone Mineral Density after Total Hip Arthroplasty with the Ribbed Anatomic Stem

2019 ◽  
Vol 2019 ◽  
pp. 1-11 ◽  
Author(s):  
Xiang-Dong Wu ◽  
Mian Tian ◽  
Yao He ◽  
Hong Chen ◽  
Yu Chen ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Femoral Stem ◽  
Mineral Density ◽  
Periprosthetic Bone ◽  
Gruen Zone ◽  
X Ray ◽  
Periprosthetic Bone Mineral Density

Background. Femoral bone remodeling around hip prosthesis after total hip arthroplasty (THA) is definite but unpredictable in time and place. This study aimed to investigate the implant-specific remodeling and periprosthetic bone mineral density (BMD) changes after implantation of the Ribbed anatomic cementless femoral stem. Methods. After power analysis, 41 patients who had undergone primary unilateral THA with the Ribbed anatomic cementless stem were included. BMD of the seven Gruen zones was measured by dual-energy X-ray absorptiometry, and the contact, fitness, and fixation of the femoral stem and proximal femur were analyzed by X-ray. Additional clinical outcome parameters were also recorded. Results. Compared with the contralateral unoperated side, significant reductions of BMD were detected in the distal zone (Gruen zone 4: 1.665±0.198 versus 1.568±0.242 g/cm2, P=0.001) and middle distal zone (Gruen zone 5: 1.660±0.209 versus 1.608±0.215 g/cm2, P=0.026) on the prosthetic side, but no significant differences in BMD were detected in other zones (Gruen zones 1, 2, 3, 6, and 7). Subgroups analyses indicated no significant correlation between periprosthetic BMD changes and clinical factors including primary disease and body mass index. Visible areas of bone ingrowth indicated solid fixation of the femoral stem and there was no case of loosening. Clinical and functional outcome scores were excellent with mean HHS of 93.13 points and mean WOMAC score of 5.20 points, and three patients described intermittent mild thigh pain at the final follow-up. Conclusions. For the Ribbed femoral stem, the periprosthetic BMD was well maintained in the proximal femur, while periprosthetic BMD was significantly reduced in the distal and middle distal zones of the femur. Further clinical investigations are required to examine the efficacy of the Ribbed stem, particularly with regard to long-term survival. This trial is registered with ChiCTR1800017750.

scholarly journals Zoledronic Acid for Periprosthetic Bone Mineral Density Changes in Patients With Osteoporosis After Hip Arthroplasty—An Updated Meta-Analysis of Six Randomized Controlled Trials

2021 ◽  
Vol 8 ◽  
Author(s):  
Yuan Liu ◽  
Jia-Wen Xu ◽  
Ming-Yang Li ◽  
Li-Min Wu ◽  
Yi Zeng ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Zoledronic Acid ◽  
Hip Arthroplasty ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Mineral Density ◽  
Periprosthetic Bone ◽  
Randomized Controlled ◽  
Periprosthetic Bone Mineral Density

Introduction: Periprosthetic bone mineral density (BMD) loss following total hip arthroplasty (THA) may threaten the survival of the implant, especially in patients with osteoporosis. Zoledronic acid (ZA) is the representative of the third generation of bisphosphonates, which were effective in reducing bone loss in conditions associated with accelerated bone turnover. The aim of this study was to evaluate the efficacy and safety of ZA in patients with osteoporosis after THA.Methods: Randomized controlled trials (RCTs) associated with ZA and THA were searched from the MEDLINE, PubMed, EMBASE, Wanfang database, and the Web of Science (August 2021). Other methods, such as hand search and email request were also tried. The methodological quality was assessed by the Risk of Bias (RoB) 2.0. Relevant data were abstracted from the included RCTs and authors were contacted when necessary.Results: In this study, six RCTs involving a total of 307 patients were finally included and analyzed. The pooled data demonstrated that significantly less periprosthetic BMD loss in Gruen zone seven had occurred in the ZA-treated patients than in the control patients at 3 months (mean difference [MD] = 4.03%; 95% CI: 0.29–7.76%; P = 0.03), 6 months (MD = 7.04%; 95% CI: 2.12–11.96%; P = 0.005), and 12 months (MD = 7.12%; 95% CI: 0.33–13.92%; P = 0.04). The Harris Hip Score (HHS) was also significantly increased in ZA group at 6 and 12 months after operation (P = 0.03 and P = 0.02, respectively). Influenza-like symptom was found related to the usage of ZA [relative risk (RR) = 7.03, P < 0.0001].Conclusion: A meta-analysis of six RCTs suggested that ZA was beneficial in maintaining the periprosthetic BMD in patients with osteoporosis at 6 and 12 months after THA. In addition, the HHS was significantly improved in patients treated with ZA. However, the short length of follow-up of the available studies resulted in the lack of analyses regarding the survival of implants including the rate of aseptic loosing, periprosthetic fracture, and revision. It still needs to be determined in research with longer follow-up period.Clinical Trial Registration:Researchregistry.com, identifier: reviewregistry1087.

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