Pre-operative bone mineral density is a predictive factor for excellent early patient-reported outcome measures in cemen
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ORIGINAL PAPER
Pre-operative bone mineral density is a predictive factor for excellent early patient-reported outcome measures in cementless total hip arthroplasty using a proximally fixed anatomic stem. A prospective study at two year minimum follow-up Elhadi Sariali 1,2
&
Nicolas Gaujac 1 & Quentin Grimal 1 & Shahnaz Klouche 3
Received: 16 May 2020 / Accepted: 22 June 2020 # SICOT aisbl 2020
Abstract Purpose The goal of the study was to analyze the impact of the pre-operative bone mineral density on the patients’ reported outcomes at two year minimum follow-up of cementless THA using a proximally fixed anatomic stem. Methods A prospective study included all patients who underwent a cementless THA using a specific proximally fixed anatomic stem and a 3D preoperative CT scan-based planning. The bone mineral density (BMD) of the metaphyseal cancellous bone was computed in a volume (of 1 mm thick and of 1 cm2 surface) at the level of the calcar 10 mm above the top of the lesser trochanter. Patients were assessed at two year follow-up using self-administered auto-questionnaires corresponding to the modified Harris (mHHS), the Oxford (OHS), and the Forgotten Hip (FHS) scores. A multiple linear regression statistical analysis was performed to assess the link between the mHHS, the age, body mass index (BMI), BMD, gender, and ASA grade. Results Fifty patients were included (29 men, 21 women), with an average age of 62 ± 12 years and an average BMI of 27 ± 5 kg/ m2. At two year follow-up, on multivariate analysis, excellent mHHS (≥ 90%) was significantly associated with only two parameters: a BMI ≤ 25 kg /m2 with an odd ratio OR = 10 (CI95% [2.1–48.3], p = 0.004) and a BMD ≥ 72 mg/cm3 with an odd ratio OR = 4.87 (CI95% [1.2–18.6], p = 0.02). Conclusion The short-term PROMs after cementless THA are impacted by pre-operative cancellous bone density. However, the BMI remains the most influential parameter on the clinical outcomes. Keywords Bone mineral density . Patient-reported outcomes . Anatomic stem . Proximal fixation . Hip arthroplasty
Introduction The success of cementless implants in total hip arthroplasty (THA) depends on the primary stability of the implants in order to enhance bone in-growth and on-growth [1]. One of the key biomechanical factors that come into play is the mechanical Level of Evidence: Therapeutic Level II * Elhadi Sariali [email protected] 1
INSERM, CNRS, Laboratoire d’Imagerie Biomédicale (LIB), Sorbonne Université, F-75006 Paris, France
2
Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, AP-HP, F-75013, 47-83 Boulevard de Hôpital, 75013 Paris, France
3
ELSAN, 58bis Rue de la Boétie, F-75008 Paris, France
quality of the bone. Gabet et al. [2] reported that implant anchorage was dependent on bone mineral density (BMD) and trabeculae struts thickness. Interestingly, they showed that a treatment with parathyroid hormone 1–34 (iahPTH) enhanced implant anchorage by increasing the struts thickness. Regarding THA, a poor mineral bone density is related to a higher risk of migration,
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