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The effect of reduced bone mineral density on elective total hip arthroplasty outcomes

  • Hip Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Reduced bone mineral density (BMD) and disruption of normal bony architecture are the characteristics of osteopenia and osteoporosis and in patients undergoing total hip arthroplasty (THA) may cause failure of trabecular ingrowth. The purpose of this study is to evaluate the impact of reduced BMD on outcomes following primary elective THA.

Methods

A retrospective chart review of 650 elective THAs with a DEXA scan in their electronic health record (EHR) from 2011 to 2020 was conducted at an urban, academic center and a regional, health center. Patients were separated into three cohorts based on their t-score and the World Health Organizations definitions: normal (t-score ≥ − 1), osteopenia (t-score < − 1.0 and > − 2.5), and osteoporosis (t-score ≤ − 2.5). Demographic and outcome data were assessed. Subsidence was assessed for patients with non-cemented THAs. Regression models were used to account for demographic differences.

Results

650 elective THAs, of which only 11 were cemented, were included in the study. Patients with osteopenia and osteoporosis were significantly older than those without (p = 0.002 and p < 0.0001, respectively) and had a lower BMI (p < 0.0001 and p < 0.0001, respectively). PFx was significantly greater in patients with osteoporosis when compared to those with normal BMD (6.5% vs. 1.0%; p = 0.04). No such difference was found between osteoporotic and osteopenic patients. The revision rate was significantly higher for osteoporotic patients than osteopenic patients (7.5% vs. 1.5%; p = 0.04). No such difference was found between the other comparison groups.

Conclusion

Patients with osteoporosis were older with reduced BMI and had increased PFx after non-cemented elective THA. Understanding this can help surgeons formulate an appropriate preoperative plan for the treatment of patients with osteoporotic bone undergoing elective THA.

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Data availability

The datasets generated and analyzed during the study are not publicly available, but may be available from the corresponding author upon reasonable request.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, NYU Langone Health, 301 E 17th St, New York, NY, 10003, USA

    Benjamin Fiedler, Vaidehi Patel, Katherine A. Lygrisse & Ran Schwarzkopf

  2. Adult Reconstructive Division, Anne Arundel Medical Center, Annapolis, MD, USA

    McKayla E. Kelly, Justin J. Turcotte & James MacDonald

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  1. Benjamin Fiedler
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  2. Vaidehi Patel
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  7. Ran Schwarzkopf
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Correspondence to Ran Schwarzkopf.

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Fiedler, B., Patel, V., Lygrisse, K.A. et al. The effect of reduced bone mineral density on elective total hip arthroplasty outcomes. Arch Orthop Trauma Surg 143, 5993–5999 (2023). https://doi.org/10.1007/s00402-023-04830-0

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