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Patients with Osteoporosis Are at Higher Risk for Periprosthetic Femoral Fractures and Aseptic Loosening Following

James T Layson1, Daniel Hameed2, Jeremy A Dubin2

  • 1Department of Orthopaedic Surgery, Lenox Hill Hospital, 100 East 77th Street, New York, NY 10075, USA.

The Orthopedic Clinics of North America
|May 23, 2024
PubMed

Insights

Patients with osteoporosis undergoing total hip arthroplasty face increased risks of femur fractures and loosening. Severe osteoporosis may elevate these risks more than previously understood.

Area of Science:

  • Orthopedic Surgery
  • Gerontology
  • Bone Metabolism

Background:

  • Osteoporosis is a growing concern in patients undergoing total hip arthroplasty (THA).
  • Comorbidities like alcohol abuse, chronic kidney disease, cerebrovascular disease, obesity, and rheumatoid arthritis are linked to complications after THA in osteoporotic patients.
  • Periprosthetic femur fracture (PPFFx) and aseptic loosening are significant concerns following THA in this population.

Purpose of the Study:

  • To provide an updated analysis of risks for patients with osteoporosis following THA.
  • To identify specific risk factors for periprosthetic femur fracture (PPFFx) and aseptic loosening in osteoporotic patients undergoing THA.
  • To evaluate the impact of bone density assessment (DEXA scans) and fixation methods on these complications.

Main Methods:

  • Retrospective analysis of patients with osteoporosis who underwent THA.
  • Examination of comorbidities including alcohol abuse, chronic kidney disease, cerebrovascular disease, obesity, and rheumatoid arthritis.
  • Correlation of dual-energy x-ray absorptiometric (DEXA) scan results with outcomes.
  • Assessment of femoral fixation methods (cemented vs. cementless).

Main Results:

  • Comorbidities remain significant risk factors for PPFFx and aseptic loosening in osteoporotic THA patients.
  • Patients with DEXA scans were at risk for PPFFx irrespective of fixation method.
  • Patients with DEXA scans and cementless fixation showed increased risk for aseptic loosening.
  • The risk of aseptic loosening and PPFFx may be higher in severe osteoporosis than previously recognized.

Conclusions:

  • Comorbidities significantly impact outcomes in osteoporotic patients after THA.
  • Bone density assessment and fixation type influence complication risks.
  • Severe osteoporosis presents a heightened risk profile for PPFFx and aseptic loosening post-THA, necessitating careful management.

Keywords:
CementlessDEXA scansOsteoporosisPeriprosthetic fracturePress-fitTotal hip arthroplasty

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