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. 2022 Sep;14(9):2210-2218.
doi: 10.1111/os.13386. Epub 2022 Aug 18.

Medium Activity Prevents Periprosthetic Bone Mass Loss in the Medial Metaphyseal Region of the Tibia after Posterior-Stabilized TKA: A 5-Year Follow-up Study of 110 Knees

Yong Liu  1 , Peiheng He  1 , Xing Li  1 , Minghao Liu  1 , Weizhi Chen  1 , Dongliang Xu  1
Affiliations

Medium Activity Prevents Periprosthetic Bone Mass Loss in the Medial Metaphyseal Region of the Tibia after Posterior-Stabilized TKA: A 5-Year Follow-up Study of 110 Knees

Yong Liu et al. Orthop Surg. 2022 Sep.

Abstract

Objective: The bone mass around the prosthesis plays an important role in the stability of the prosthesis. This study aimed to assess the effect of postoperative activity on bone mineral density (BMD) in the proximal tibia 5 years after total knee arthroplasty (TKA). To provide a scientific guidance for postoperative functional exercise.

Methods: 110 patients underwent unilateral primary TKA were divided into three groups based on the University of California Los Angeles (UCLA) activity scale: low activity group (LA group, UCLA = 4, 5); medium activity group (MA group, UCLA = 6, 7); and high activity group (HA group, UCLA = 8, 9). The primary observation was a comparison of the BMD and BMD change percentage (ΔBMD (%)) in the periprosthetic tibia among the LA, MA and HA groups at 1 year, 3 years and 5 years. The secondary observations were radiographic evaluation (prosthetic stability, periprosthetic fractures, aseptic loosening and periprosthetic joint infection) and clinical evaluation (Knee Society Score (KSS), visual analogue score scores and range of motion (ROM)). A one-way ANOVA was used to compare the clinical scores and BMD among the three groups.

Results: The BMD of medial region decreased by 10.80%, 12.64%, 13.61% at 1, 3, and 5 years respectively; these were 5.72%, 6.26%, 7.83% in lateral region and 1.42%, 1.78%, 3.28% in diaphyseal region. For medial metaphyseal region, the BMD of the MA group was significantly greater than that of the LA and HA groups at 1 and 3 years (108.9 ± 5.2 vs. 106.1 ± 6.69 vs. 105.4 ± 5.2 and 108.5 ± 6.0 vs. 101.2 ± 6.76 vs. 103.0 ± 6.8, P < 0.01 and P < 0.001), and the BMD changes (ΔBMD (%)) in the MA group were significantly smaller than those in the LA and HA groups (8.75 ± 5.36 vs. 11.92 ± 5.49 vs. 12.70 ± 5.21 and 9.11 ± 5.11 vs. 16.04 ± 4.79 vs. 14.82 ± 4.26, P < 0.01 and P < 0.001). Regarding secondary observations, all of the prostheses were assessed as stable, without periprosthetic fractures, aseptic loosening and periprosthetic joint infection. Regarding KSS scores, there was no significant difference among the three groups. However, the VAS and ROM of the HA group were better than those of the MA and LA groups (1.65 ± 0.79 vs. 2.63 ± 0.77 vs. 3.00 ± 1.17, p < 0.001, and 111.90 ± 9.17 vs. 110.20 ± 6.78 vs. 102.90 ± 8.48, P < 0.001).

Conclusion: Medium activity prevented periprosthetic bone loss in the medial metaphyseal region of the tibia after posterior-stabilized TKA, and moderate-intensity exercise is recommended for patients after TKA to reduce periprosthetic bone loss.

Keywords: Activity level; Bone loss; Bone mineral density; Prosthetic loosening; Total knee arthroplasty.

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Figures

Fig. 1
Fig. 1
(A) Schematic diagram of lower limb x‐ray photography, the patients' knee joint was controlled in a neutral position by black bind to reduce errors caused by differences in the position of the knee. Knee flexion was minimized by fixing the tibial tubercle at the lower end of the knee. Rotation was controlled by fixing the heel and the first and second toes. (B) rBMD was measured at 3 regions of interest around the tibial component on X‐ray film, R1: medial metaphyseal region, R2: lateral metaphyseal region, R3: diaphyseal region. Regions a and f measured the gray values of air and metal in the femoral prosthesis, respectively, to adjust the bone density. The measured area avoided cement, cortical bone, and the fibula head
Fig. 2
Fig. 2
Flow diagram of the study. LA, low activity; MA, medium activity; HA, high activity
Fig. 3
Fig. 3
All 110 patients' average rBMD change curve in R1, R2 and R3 within 5 follow‐up years. The rBMD decreased over time significantly and the most severe at medial region (R1)
Fig. 4
Fig. 4
Figures showed the effect of activity level on medial rBMD. A: shows the average rBMD change curve over time. The average rBMD of LA MA and HA groups declined over time but the rBMD of MA group was significantly higher than LA and HA groups at 1 and 3 years. There was no significant difference between LA group and HA group. B: shows the Δ BMD (%) among LA MA and HA groups at 1 year and 3 years. The Δ BMD (%) of MA group was significantly lower than LA and HA group both at 1 year and 3 years. There was no significant difference between LA and HA groups. *: P < 0.05, **: P < 0.01, ***: P < 0.001
See this image and copyright information in PMC

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