Issues

Is bone mineral density important in hip arthroplasty?

Journal: Osteologie
ISSN: 1019-1291
Topic:

Kalzium-Phosphat-Stoffwechsel und Knochen

Issue: Issues of 2017 (Vol. 26): HeIssue 3 2017 (131-191)
Pages: 157-163

Is bone mineral density important in hip arthroplasty?

Ergebnisse einer Online-Umfrage aus Deutschland, Österreich und der Schweiz

G. S. Maier, K. Kolbow

Keywords

Hip Arthroplasty, DXA, bone mineral density

Summary

Background: Cementless techniques and short-stem design are popular implant designs in hip arthroplasty, but these were originally designed for patients with normal bone structure. In patients scheduled to undergo total joint arthroplasty, the bone quality around the joint affects the safety of prosthetic implantation and furthermore the satisfaction with the postoperative outcome. Bone strength is clinically assessed by measuring bone mineral density using dual-energy X-ray absorptiometry, therefore we asked if bone mineral density is of any importantance to orthopaedic surgeons performing hip arthroplasty. Methods: A 14-question survey was administered to orthopaedic surgeons who are performing hip arthroplasty on a regular level. The survey was distributed by e-mail to the members of several national orthopaedic associations in Germany, Switzerland and Austria. Orthopaedic surgeons were asked about treatment patterns with respect to bone mineral density, osteoporosis work up and treatment for patients with low bone mineral density scheduled to undergo hip arthroplasty. Results: Four national orthopaedic associations (Swiss orthopaedics, Dachverband Osteologie, Austrian Orthopaedic Association, Orthopaedic Association of Southern Germany) asked their members to fill out the online-survey. 340 completed questionnaires were available for analyses. 72 % of all asked orthopaedic surgeons reported to use cementless implants as a standard in hip arthroplasty. A known osteoporosis in patient´s history influences 46 % of the surgeons in their decision making process. Over 60 % of those queried reported that low bone mineral density is a reason to reconsider treatment and operation strategies, but only 4 % performed bone mineral density measurement on a regular base preoperatively. 25 % would change their treatment strategy in case of a bone mineral density (T-Score) between –1.5 and –2, 39 % in case of a T-score between –2 and –2.5, and 30 % would change their intraop strategy if a T-score smaller –2.5 was measured. 94 % of all asked orthopaedic specialists would change from cementless to cemented implants. If the suspicion of osteoporosis arises intraoperatively 22 % would start with diagnostic (measurement of BMD, metabolic laboratory), 78 % would recommend osteoporosis diagnostic after the hospital stay. If the diagnosis if osteoporosis is secured, 58 % of those queried would immediately start medical osteoporosis therapy according to national guidelines. 25 % would recommend to start osteoporotic therapy in an ambulant set up. Conclusion: Despite of the large number of elderly patients receiving hip arthroplasty and the high incidence of osteoporosis and osteomalacia in this population, the majority of orthopaedic surgeons who responded to the survey reported that they do not perform routine measurement of bone mineral density before arthroplastic surgery. However, most surgeons commented that low bone mineral density will influence their surgical plan and the implant design. Due to the demographic change orthopaedic surgeons will be faced regularly with osteoporosis and osteomalacia while performing arthroplastic surgeries, resulting in an increasing need for awareness among orthopaedic surgeons regarding bone mineral density, osteoporosis screening and treatment.

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