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Patients with Periprosthetic Femoral Hip Fractures are Commonly Classified as Having Osteoporosis Based on DXA Measurements.

ABSTRACT: Periprosthetic femoral hip fractures are subject to an increasing incidence and are often considered to be related to osteoporosis. However, there are no available studies that have determined the frequency of osteoporosis in affected patients using gold standard dual-energy X-ray absorptiometry (DXA). In this retrospective comparative study, we analyzed the DXA results of 40 patients with periprosthetic femoral hip fractures who were treated surgically in our department. DXA measurements were performed at the total hip and the lumbar spine to determine bone mineral density T-scores. Data were compared to two age-, sex-, and BMI-matched control groups in which patients underwent DXA prior to aseptic revision surgery for other causes or primary THA (consisting of 40 patients each). The mean T-score in the periprosthetic fracture cohort was significantly lower (- 1.78 ± 1.78) than that of the aseptic revision (- 0.65 ± 1.58, mean difference - 1.13 [95% CI - 1.88 to - 0.37]; p = 0.001) and the primary THA cohort (- 0.77 ± 1.34, mean difference - 1.01 [95% CI - 1.77 to - 0.26]; p = 0.005). Accordingly, osteoporosis was detected more frequently (45%) in the fracture cohort compared to patients undergoing aseptic revision (12.5%) and primary THA (10%). In conclusion, almost half of the patients with periprosthetic femoral hip fractures have osteoporosis according to DXA measurements. A regular assessment of bone health in THA enables identification of patients with osteoporosis who likely benefit from initiation of osteoporosis medication and cemented stem fixation.

SUBMITTER: Ritter J

PROVIDER: S-EPMC11246254 | biostudies-literature | 2024 Aug

REPOSITORIES: biostudies-literature

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Patients with Periprosthetic Femoral Hip Fractures are Commonly Classified as Having Osteoporosis Based on DXA Measurements.

Ritter Jacob J Alimy Assil-Ramin AR Simon Alexander A Hubert Jan J Ries Christian C Rolvien Tim T Beil Frank Timo FT

Calcified tissue international 20240604 2

Periprosthetic femoral hip fractures are subject to an increasing incidence and are often considered to be related to osteoporosis. However, there are no available studies that have determined the frequency of osteoporosis in affected patients using gold standard dual-energy X-ray absorptiometry (DXA). In this retrospective comparative study, we analyzed the DXA results of 40 patients with periprosthetic femoral hip fractures who were treated surgically in our department. DXA measurements were p ...[more]

PMID: 38833002

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Project description:ObjectivePeriprosthetic fracture in total hip arthroplasty (THA) can be catastrophic, and early detection and appropriate management are vital to the overall prognosis. This study aimed to describe and summarize the features of undetected intraoperative periprosthetic femoral fractures (IPFFs) in primary THA patients and treatment measures and to review the relevant literature.MethodsWe reviewed a total of 6350 primary THAs performed at our institution between January 2013 and December 2020 and screened all IPFFs. Of 138 IPFFs, 24 were undetected and met the inclusion criteria. We recorded and compared basic patient and operative information and measured some parameters to evaluate canal morphologies based on preoperative radiographs. We also compared fracture line characteristics using postoperative radiographs to summarize the features of intraoperative fractures and propose treatment strategies. The Kolmogorov-Smirnov test was used to test the normality of the variable distributions. Measured parameters in all groups were analyzed using one-way analysis of variance and compared using Dunnett's test. The χ2 and Fisher exact tests were used to compare reoperation rates across the groups. Interrater and intrarater reliability were evaluated by intraclass correlation coefficients.ResultsAmong the 24 hips, there was no significant difference in patient demographics, basic operative information or morphology. The incidence of IPFFs in primary THA patients was 2.17%, and up to 17.4% of IPFFs were undetected until postoperative fluoroscopy. The incidence of undetected IPFFs among all primary THA patients was 0.38% and varied by stem type, with the highest incidence in femurs with either anatomical (1.04%, 4/385) or modular stems (0.90%, 9/1003). Femurs with anatomical stems had a higher reoperation rate. The distal periprosthetic (Gruen zone 4) fracture line of femurs with tapered stems was more prone to involve the medial or lateral bone cortex, which could cause instability.ConclusionAn undetected IPFF is most likely in femurs fitted with a prosthesis of an inappropriate size or type. Anatomical stems will most likely cause unstable fractures; thus, it is recommended to use them with caution and note the possibility of medial distal femoral fracture. Improper modular stem type or size selection results in longitudinal fractures of the distal femur, and prophylactic cerclage wire binding is recommended in dysplastic hips. Incorrect use of tapered stems in well-ossified femurs may cause distal femoral fractures involving the medial or lateral bone cortex. Intraoperative fluoroscopy after implantation may help detect hidden fractures.

Project description:A bone fractures only when loaded beyond its strength. The purpose of this study was to determine the association of femoral strength, as estimated by finite element (FE) analysis of dual-energy X-ray absorptiometry (DXA) scans, with incident hip fracture in comparison to hip bone mineral density (BMD), Fracture Risk Assessment Tool (FRAX), and hip structure analysis (HSA) variables. This prospective case-cohort study included a random sample of 1941 women and 668 incident hip fracture cases (295 in the random sample) during a mean?±?SD follow-up of 12.8?±?5.7 years from the Study of Osteoporotic Fractures (n?=?7860 community-dwelling women ?67 years of age). We analyzed the baseline DXA scans (Hologic 1000) of the hip using a validated plane-stress, linear-elastic finite element (FE) model of the proximal femur and estimated the femoral strength during a simulated sideways fall. Cox regression accounting for the case-cohort design assessed the association of estimated femoral strength with hip fracture. The age-body mass index (BMI)-adjusted hazard ratio (HR) per SD decrease for estimated strength (2.21; 95% CI, 1.95-2.50) was greater than that for total hip (TH) BMD (1.86; 95% CI, 1.67-2.08; p?<?0.05), FN BMD (2.04; 95% CI, 1.79-2.32; p?>?0.05), FRAX scores (range, 1.32-1.68; p?<?0.0005), and many HSA variables (range, 1.13-2.43; p?<?0.005), and the association was still significant (p?<?0.05) after further adjustment for hip BMD or FRAX scores. The association of estimated strength with incident hip fracture was strong (Harrell's?C index 0.770), significantly better than TH BMD (0.759; p?<?0.05) and FRAX scores (0.711-0.743; p?<?0.0001), but not FN BMD (0.762; p?>?0.05). Similar findings were obtained for intracapsular and extracapsular fractures. In conclusion, the estimated femoral strength from FE analysis of DXA scans is an independent predictor and performs at least as well as FN BMD in predicting incident hip fracture in postmenopausal women.

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Patients with Periprosthetic Femoral Hip Fractures are Commonly Classified as Having Osteoporosis Based on DXA Measurements.

Publications

Patients with Periprosthetic Femoral Hip Fractures are Commonly Classified as Having Osteoporosis Based on DXA Measurements.

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