Monitoring the reduction and maintenance of periprosthetic bone tissue in cementless primary hip endoprosthesis with alendronate therapy

Ilir Shabani,Neron Popovski,Shaban Memeti,Milan Samardziski,Viktor Kamnar,Antonio Gavrilovski

doi:10.3889/aph.2021.6002

Abstract

Loss of periprosthetic bone tissue in primary hip endoprostheses is common in clinical practice. This loss can be progressive and in extreme conditions can jeopardize the longevity of the prosthesis. In order to monitor the function of Alendronate therapy for bone maintenance, the study included 50 patients with implanted total cement-free hip endoprosthesis (TPH). The first group of 25 patients received Alendronate, calcium and vitamin D3 orally postoperatively. The second group of 25 patients were examined postoperatively without therapy. Patients were followed by radiographic and dual-energy X-ray absorptiometry (DXA) at 6 and 12 months. The study showed that in patients with TPH there was a difference in the X-ray findings as well as occurrence of osteolysis in certain Gruen zones, which was confirmed by changes in the state of bone mineral density (BMD) and bone mineral content (BMC) in the interval between 6 and 12 months using the DXA method. Alendronate therapy after TPH implantation allows reduction of periprosthetic bone mass loss, maintenance of bone mineralization and implant hardening.

Highlights

Poor bone quality is a significant risk factor when implanting a total hip arthroplasty (TPH)
The clinical material consisted of 50 patients treated at the University Clinic for Orthopedic Diseases with implantation of a total hip endoprosthesis in the period from 2018 to 2020 due to degenerative hip diseases
Six months after surgery (Table 4), no significant difference in bone mineral density (BMD parameter) was found between patients treated with Alendronate and those without medication

Summary

Introduction

Poor bone quality is a significant risk factor when implanting a total hip arthroplasty (TPH). The loss of bone mass affects the longevity and stability of the implant. Periprosthetic bone loss is present in both cement and non-cement hip prostheses. When an endoprosthesis is implanted, the proximal part of the femur is surrounded by a spongy bone. The distal end of the endoprosthesis is in contact with a predominantly cortical bone. This provides a variety of biological and biomechanical conditions for TPH implantation. Body weight changes from proximal to distal. This imbalance of load forces causes bone resorption mechanisms under Wolf’s law. This bone loss is seen in the proximal femur 3-5

Methods

Discussion

Conclusion