Abstract
Purpose:The preoperative prevalence of osteoporosis and/or osteopenia and overall bone quality in prospective total knee arthroplasty (TKA) patients may affect the postoperative outcome after prosthetic insertion into the bone. The purpose of this study is to determine the baseline bone mineral density (BMD) and bone turnover in preoperative, female, primary TKA patients.Methods:We prospectively measured the lumbar spine and hip BMDs using dual-energy X-ray absorptiometry (DEXA) scans in a cohort of 119 knees (107 patients) one day before surgery. We also assessed bone turnover using urinary levels of N-telopeptide (NTX), a type I collagen crosslinker, normalized to creatinine.Results:The prevalence of osteoporosis by DEXA scan (T-score ≤ −2.5) among the TKAs was 12% in the spine and 10% in the hip. Eighty-three knees (70%) had osteopenia or osteoporosis of either the spine or hip. The mean T-score of the spine was −0.7 (SD 1.6), which is within normal limits, and of the hip was −1.2 (SD 1.0), which is defined as osteopenia. The mean Z-scores of 0.9 (SD 1.4) in the spine and 0.6 (SD 0.9) in the hip were positive. The median urinary NTX/creatinine ratio was elevated at 58.1 (interquartile range: 13.7 to 188.4).Conclusion:Based on Z-scores, the TKA patients had higher spine and hip BMDs than the age-matched general population. Elevated NTX levels may suggest a systemic or local abnormal bone turnover. Further study is needed to determine whether such turnover, as a type of patient-related medical systemic disorder, affects postoperative clinical outcomes.
Highlights
Osteoarthritis and osteoporosis, which are common diseases in women over the age of 65, can be present simultaneously, especially in patients with chronic arthritis [1], though the prevalence depends on patient age, lifestyle, and environment
Several papers [2 - 4] have reported the prevalence of osteoporosis in patients with advanced knee osteoarthritis who are undergoing total knee arthroplasty (TKA)
The results of two studies demonstrated that bisphosphonates, which prevent bone resorption, significantly reduce the rate of revision surgery [8] and increases the T-score hip bone mineral density (BMD) after TKA [9]
Summary
Osteoarthritis and osteoporosis, which are common diseases in women over the age of 65, can be present simultaneously, especially in patients with chronic arthritis [1], though the prevalence depends on patient age, lifestyle, and environment. Many recent studies on TKA surgery have examined implant design and relatively few have assessed the quality of the bone into which the implants are inserted [5]. The most common cause leading to revision knee arthroplasty is the aseptic loosening of components [6, 7] that occurs when periprosthetic bone is resorbed because of surgeon-related factors such as malalignment, patient-related factors such as bone quality, or implant-related factors such as cemented or cementless fixation or design, among others [6]. The results of two studies demonstrated that bisphosphonates, which prevent bone resorption, significantly reduce the rate of revision surgery [8] and increases the T-score hip bone mineral density (BMD) after TKA [9]. Several studies did not find any beneficial effects of bisphosphonate treatment [10 - 12]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
