Periprosthetic Bone Mineral Density Around Uncemented Titanium Stems in the Second and Third Decade After Total Hip Arthroplasty: A DXA Study After 12, 17 and 21 Years

Implant failure and periprosthetic fractures because of periprosthetic bone loss are a major concern in total hip arthroplasty (THA). Hardly any clinical data exist on the long-term evolution of bone mineral density (BMD) around uncemented femoral implants. The question to address is whether relevant bone loss continues into third decade around well-fixed uncemented femoral implants. BMD around stable uncemented straight titanium femoral implants was assessed in a longitudinal cohort study. We included 142 hips of 128 patients and measured the development of the periprosthetic BMD using dual-energy X-ray absorptiometry. The baseline measurement was 12 years (t₁) after the implantation of an uncemented femoral stem. Follow-up-measurements were performed at 17 (t₂) and at 21 years (t₃) after primary THA. The regions of interest (ROI) were selected conforming to Gruen et al. We acquired complete data including three consecutive measurements (t₁, t₂, t₃) for 42 patients (49 hips). Performing radiographic evaluation at t₁, t₂ and t₃, we found a regular bone-implant interface present in all cases. Significant decrease in BMD could be shown in ROI 1 (p = 0.0001; − 7.8%), 4 (p = 0.024; − 2.4%), 6 (p = 0.001; − 5.5%) and 7 (p < 0.0001; − 11.7%) between t₁ and t₃ and in ROI 1 (p = 0.002; − 3.7%), 2 (p = 0.046; − 3.6%), 4 (p = 0.002; − 2.7%) and 7 (p < 0.0001; − 8.0%) between t₂ and t₃. There were significant differences in overall bone density (netavg) between t₁ and t₃ (p = 0.001; − 3.6%) and between t₂ and t₃ (p = 0.020; − 2.1%). The data indicate clinically relevant changes of BMD especially in the proximal Gruen zones in the long-term after uncemented THA. Loss of periprosthetic BMD might be a risk factor for periprosthetic fractures.