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Does bone quality predict loosening of cemented total hip replacements?
1Department of Orthopaedics, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK. mfnixon@gmail.com
The Journal of Bone and Joint Surgery. British Volume
|October 25, 2007
Summary
Poor bone quality, including lower bone mineral density and narrower femoral cortices, is linked to aseptic loosening in cemented total hip replacements (THR). Patients with THR require osteoporosis screening and regular radiological monitoring.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
- Geriatric Medicine
Background:
- Aseptic loosening is a primary cause of total hip replacement (THR) failure.
- Understanding factors predisposing to loosening is crucial for improving long-term implant survival.
Purpose of the Study:
- To investigate whether poor bone quality predisposes patients to aseptic loosening of cemented Charnley Elite Plus total hip replacements (THR).
Main Methods:
- Matched cohort study comparing 78 patients with loose THR to 49 with stable THR.
- Assessment of clinical, radiological, biomechanical, and bone mineral density (BMD) indicators of bone quality.
Main Results:
- Loose THR patients exhibited more pain, atrophic arthritis, fragility fractures, narrower femoral cortices, and lower peri-prosthetic/lumbar spine BMD (p < 0.01).
- Smokers were more prevalent in the loose THR group (p = 0.08).
- Vitamin D deficiency was common but not significantly different between groups (p = 0.31).
Conclusions:
- Aseptic loosening in cemented THR is associated with compromised bone quality.
- Recommend osteoporosis screening and regular radiological surveillance for THR patients.
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