Femoral Bone Atrophy after Cementless Total Hip Arthroplasty : Examination of the Bone Metabolic Markers

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  • セメントレス人工股関節全置換術後の大腿骨の骨萎縮について : 骨代謝マーカーの検討
  • セメントレス ジンコウ コ カンセツ ゼン チカン ジュツゴ ノ ダイタイコツ ノ コツ イシュク ニ ツイテ コツ タイシャ マーカー ノ ケントウ

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The causes of bone atrophy around the stem after cementless total hip arthroplasty (THA) observed by imaging techniques are unclear and few studies have analyzed the pathology of bone atrophy from the standpoint of bone metabolism. This study examined whether changes in bone metabolic markers could be used to predict bone atrophy. To define bone atrophy, the femoral index was used for the femoral shaft and bone mineral density was used for the trochanter. Fifty patients who had received cementless THA 18 months to 3 years (mean, 2 years and a month) prior to the study and 20 patients who had not been surgically treated were the subjects of the study. The surgical patients were divided into two groups: 37 patients with bone atrophy (Group a) and 13 patients without bone atrophy (Group b). The non-operative patients were Group c. Bone atrophy developed most frequently at 24 to 48 weeks postoperatively in the bone shaft and 12 to 48 weeks postoperatively in the trochanter. Deoxypyridinoline (DPD) and pyridinoline (PYD) levels were significantly elevated in both Groups a and b at 4 weeks postoperatively. Levels increased until 8 weeks postoperatively in Group a but decreased in Group b and a significant difference was observed between the groups at eight weeks. All of the patients in Group a with increases in DPD and PYD levels of 20% or greater from four to eight weeks postoperatively experienced bone atrophy. This indicates the importance of analysis of bone resorption markers during this period and measures based on these results. The use of bone resorption markers may allow early quantification of small changes in bone metabolism that cannot be detected with radiography or bone mineral density analysis. Thus, these markers may be useful for predicting femoral bone atrophy after THA and taking measures to control it.

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