Restoration of Proximal Periprosthetic Bone Loss by Denosumab in Cementless Total Hip Arthroplasty

Overview

Journal Eur J Orthop Surg Traumatol

Specialty Orthopedics

Date 2018 May 19

PMID 29774416

Citations 12

Authors

Satoshi Nagoya

Kenji Tateda

Shunichiro Okazaki

Ima Kosukegawa

Junya Shimizu

Toshihiko Yamashita

Affiliations

Soon will be listed here.

Abstract

Introduction: Although bone quality is an important issue in elderly osteoporotic patients who underwent total hip arthroplasty (THA) with a cementless stem, periprosthetic bone mineral density (BMD) in the proximal femur has been reported to be decreased by 15-40% postoperatively. Some authors have examined the use of several types of bisphosphonates to prevent decreases in BMD in the proximal femur after cementless THA; however, few reports have demonstrated success in restoring BMD in the proximal medial femoral bone, such as zone 7.

Methods: We conducted prospective study comparing patients who underwent cementless THA administered with denosumab (10 patients) and without denosumab (10 patients). BMD around the femoral stem were measured using a DEXA immediately after surgery, and at 6 months and at 1 year after surgery. No difference was found between the two groups referred to the patient's demographic data.

Results: We found that denosumab displayed definitive effects in increasing the % change in periprosthetic BMD at zone 7 by an average of 7.3% in patients with cementless THA, compared to control group who were given only vitamin D.

Conclusion: Denosumab is one of a number of anti-osteoporotic agents to have a definitive effect on the restoration of proximal periprosthetic bone loss, especially in zone 7, after cementless THA. Denosumab contributed to the restoration of decreased periprosthetic BMD to normal levels. As the decrease in BMD in the proximal femur after THA is considered to be apparent at 6-12 months after surgery, it is believed that prevention of the deterioration of bone quality is important in the proximal femur immediately after cementless THA for elderly female patients with osteoporosis.

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Comparing the Efficacy of Antiosteoporotic Drugs in Preventing Periprosthetic Bone Loss Following Total Hip Arthroplasty: A Systematic Review and Bayesian Network Meta-Analysis.

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Morita A, Iida Y, Inaba Y, Tezuka T, Kobayashi N, Choe H Bone Joint Res. 2024; 13(4):184-192.

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References

Alm J, Makinen T, Lankinen P, Moritz N, Vahlberg T, Aro H . Female patients with low systemic BMD are prone to bone loss in Gruen zone 7 after cementless total hip arthroplasty. Acta Orthop. 2009; 80(5):531-7. PMC: 2823339. DOI: 10.3109/17453670903316801. View

Pitto R, Hayward A, Walker C, Shim V . Femoral bone density changes after total hip arthroplasty with uncemented taper-design stem: a five year follow-up study. Int Orthop. 2009; 34(6):783-7. PMC: 2989021. DOI: 10.1007/s00264-009-0884-0. View

Lerch M, Kurtz A, Windhagen H, Bouguecha A, Behrens B, Wefstaedt P . The cementless Bicontact stem in a prospective dual-energy X-ray absorptiometry study. Int Orthop. 2012; 36(11):2211-7. PMC: 3479282. DOI: 10.1007/s00264-012-1616-4. View

Jahnke A, Engl S, Altmeyer C, Jakubowitz E, Seeger J, Rickert M . Changes of periprosthetic bone density after a cementless short hip stem: a clinical and radiological analysis. Int Orthop. 2014; 38(10):2045-50. DOI: 10.1007/s00264-014-2370-6. View

Scott D, Woltz J, Smith R . Effect of zoledronic acid on reducing femoral bone mineral density loss following total hip arthroplasty: preliminary results of a prospective randomized trial. J Arthroplasty. 2012; 28(4):671-5. DOI: 10.1016/j.arth.2012.08.007. View

Nysted M, Benum P, Klaksvik J, Foss O, Aamodt A . Periprosthetic bone loss after insertion of an uncemented, customized femoral stem and an uncemented anatomical stem. A randomized DXA study with 5-year follow-up. Acta Orthop. 2011; 82(4):410-6. PMC: 3237029. DOI: 10.3109/17453674.2011.588860. View

Fokter S, Sarler T, Strahovnik A, Repse-Fokter A . Results of total hip arthroplasty using a bionic hip stem. Int Orthop. 2014; 39(6):1065-71. DOI: 10.1007/s00264-014-2623-4. View

Skoldenberg O, Salemyr M, Boden H, Ahl T, Adolphson P . The effect of weekly risedronate on periprosthetic bone resorption following total hip arthroplasty: a randomized, double-blind, placebo-controlled trial. J Bone Joint Surg Am. 2011; 93(20):1857-64. DOI: 10.2106/JBJS.J.01646. View

Kwon D, Lee T, Kang J, Moon K . Correlation between stress shielding and clinical outcomes after total hip arthroplasty with extensively porous coated stems. J Arthroplasty. 2013; 28(10):1728-30. DOI: 10.1016/j.arth.2013.06.036. View

10.

Orwoll E, Teglbjaerg C, Langdahl B, Chapurlat R, Czerwinski E, Kendler D . A randomized, placebo-controlled study of the effects of denosumab for the treatment of men with low bone mineral density. J Clin Endocrinol Metab. 2012; 97(9):3161-9. DOI: 10.1210/jc.2012-1569. View

11.

Yamada H, Yoshihara Y, Henmi O, Morita M, Shiromoto Y, Kawano T . Cementless total hip replacement: past, present, and future. J Orthop Sci. 2009; 14(2):228-41. PMC: 2779384. DOI: 10.1007/s00776-008-1317-4. View

12.

Aro H, Alm J, Moritz N, Makinen T, Lankinen P . Low BMD affects initial stability and delays stem osseointegration in cementless total hip arthroplasty in women: a 2-year RSA study of 39 patients. Acta Orthop. 2012; 83(2):107-14. PMC: 3339522. DOI: 10.3109/17453674.2012.678798. View

13.

Kroger H, Miettinen H, Arnala I, Koski E, Rushton N, Suomalainen O . Evaluation of periprosthetic bone using dual-energy x-ray absorptiometry: precision of the method and effect of operation on bone mineral density. J Bone Miner Res. 1996; 11(10):1526-30. DOI: 10.1002/jbmr.5650111020. View

14.

Boonen S, Adachi J, Man Z, Cummings S, Lippuner K, Torring O . Treatment with denosumab reduces the incidence of new vertebral and hip fractures in postmenopausal women at high risk. J Clin Endocrinol Metab. 2011; 96(6):1727-36. DOI: 10.1210/jc.2010-2784. View

15.

Matsumoto T, Kaneuji A, Hiejima Y, Sugiyama H, Akiyama H, Atsumi T . Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ): a patient-based evaluation tool for hip-joint disease. The Subcommittee on Hip Disease Evaluation of the Clinical Outcome Committee of the Japanese Orthopaedic Association. J Orthop Sci. 2011; 17(1):25-38. PMC: 3265722. DOI: 10.1007/s00776-011-0166-8. View

16.

Fokter S, Komadina R, Repse-Fokter A, Yerby S, Kocijancic A, Marc J . Etidronate does not suppress periprosthetic bone loss following cemented hip arthroplasty. Int Orthop. 2005; 29(6):362-7. PMC: 2231584. DOI: 10.1007/s00264-005-0018-2. View

17.

Zebaze R, Libanati C, Austin M, Ghasem-Zadeh A, Hanley D, Zanchetta J . Differing effects of denosumab and alendronate on cortical and trabecular bone. Bone. 2013; 59:173-9. DOI: 10.1016/j.bone.2013.11.016. View

18.

Spittlehouse A, Smith T, Eastell R . Bone loss around 2 different types of hip prostheses. J Arthroplasty. 1998; 13(4):422-7. DOI: 10.1016/s0883-5403(98)90008-0. View

19.

Gibbons C, Davies A, Amis A, Olearnik H, Parker B, Scott J . Periprosthetic bone mineral density changes with femoral components of differing design philosophy. Int Orthop. 2001; 25(2):89-92. PMC: 3620635. DOI: 10.1007/s002640100246. View

20.

Smolders J, Hol A, Rijnders T, VAN Susante J . Changes in bone mineral density in the proximal femur after hip resurfacing and uncemented total hip replacement: A prospective randomised controlled study. J Bone Joint Surg Br. 2010; 92(11):1509-14. DOI: 10.1302/0301-620X.92B11.24785. View