Restoration of proximal periprosthetic bone loss by denosumab in cementless total hip arthroplasty

Eur J Orthop Surg Traumatol. 2018 Dec;28(8):1601-1607. doi: 10.1007/s00590-018-2223-x. Epub 2018 May 17.

Abstract

Denosumab contributed to the restoration of proximal periprosthetic bone loss around the femoral stem that were measured using a DEXA, especially in zone 7, at 1 year after cementless THA in elderly osteoporotic patients.

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.

Keywords: Bone mineral density; Denosumab; Femoral bone atrophy; Stress shielding; Total hip arthroplasty.

MeSH terms

  • Absorptiometry, Photon / methods
  • Aged
  • Arthroplasty, Replacement, Hip* / adverse effects
  • Arthroplasty, Replacement, Hip* / methods
  • Bone Density
  • Bone Density Conservation Agents / administration & dosage
  • Bone Diseases, Metabolic* / diagnosis
  • Bone Diseases, Metabolic* / etiology
  • Bone Diseases, Metabolic* / prevention & control
  • Denosumab / administration & dosage*
  • Female
  • Follow-Up Studies
  • Hip Joint / diagnostic imaging
  • Hip Joint / surgery
  • Humans
  • Osteoporosis* / diagnosis
  • Osteoporosis* / etiology
  • Osteoporosis* / physiopathology
  • Osteoporosis* / therapy
  • Periprosthetic Fractures / etiology
  • Periprosthetic Fractures / prevention & control
  • Postoperative Complications* / diagnosis
  • Postoperative Complications* / etiology
  • Postoperative Complications* / prevention & control
  • Prospective Studies

Substances

  • Bone Density Conservation Agents
  • Denosumab