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Meta-Analysis
. 2023 Apr 27:94:191-199.
doi: 10.2340/17453674.2023.11635.

Change in CT-measured acetabular bone density following total hip arthroplasty: a systematic review and meta-analysis

Thomas S Robertson  1 , Bart G Pijls  2 , Zachary Munn  3 , L Bogdan Solomon  4 , Rob G H H Nelissen  2 , Stuart A Callary  4
Affiliations
Meta-Analysis

Change in CT-measured acetabular bone density following total hip arthroplasty: a systematic review and meta-analysis

Thomas S Robertson et al. Acta Orthop. .

Abstract

Background and purpose: Assessing peri-acetabular bone quality is valuable for optimizing the outcomes of primary total hip arthroplasty (THA) as preservation of good quality bone stock likely affects implant stability. The aim of this study was to perform a meta-analysis of peri-acetabular bone mineral density (BMD) changes over time measured using quantitative computer tomography (CT) and, second, to investigate the influence of age, sex, and fixation on the change in BMD over time.

Methods: A systematic search of Embase, Scopus, Web of Science, and PubMed databases identified 19 studies that measured BMD using CT following THA. The regions of interest (ROI), reporting of BMD results, and scan protocols were extracted. A meta-analysis of BMD was performed on 12 studies that reported measurements immediately postoperatively and at follow-up.

Results: The meta-analysis determined that periacetabular BMD around both cemented and uncemented components decreases over time. The amount of BMD loss increased relative to proximity of the acetabular component. There was a greater decrease in cortical BMD over time in females and cancellous BMD for young patients of any sex.

Conclusion: Peri-acetabular BMD decreases at different rates relative to its proximity to the acetabular component. Cancellous BMD decreases more in young patients and cortical bone decreases more in females. Standardized reporting parameters and suggested ROI to measure peri-acetabular BMD are proposed, to enable comparison between implant and patient variables in the future.

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Figures

Figure 1
Figure 1
Proposed ROIs 1–8 on a plain radiograph (left) and coronal CT (right) and below the dorsal regions of interest (left) and ventral (right) for ROI 6.
Figure 2
Figure 2
Prisma chart of Covidence review process.
Figure 3
Figure 3
Examples of different regions of interest used in previous CT studies of peri-acetabular BMD following THA.
Figure 4
Figure 4
Forest plots meta-analysis of cortical and cancellous bone. Note all eligible studies included for each subgroup. Those not estimable have been omitted.
Figure 5
Figure 5
Changes in cancellous bone. A. Bone loss relative to age at early follow-up. B. Bone loss relative to time at early follow-up. C. Bone loss relative to region of interest.
Figure 6
Figure 6
Changes in cortical bone. A. Bone loss relative to region of interest. B. Bone loss relative to sex by percentage of women.
See this image and copyright information in PMC

References

    1. Ries M D, Scott M L, Jani S. Relationship between gravimetric wear and particle generation in hip simulators: conventional compared with cross-linked polyethylene. J Bone Joint Surg Am 2001; 83-A(Suppl. 2, Pt 2): 116-22. doi: 10.2106/00004623-200100022-00009. - DOI - PubMed
    1. AOANJRR . Australian Orthopaedics Association National Joint Replacement Registry Annual Report. Adelaide: AOA; 2020.
    1. Maier G S, Kolbow K, Lazovic D, Maus U. The importance of bone mineral density in hip arthroplasty: results of a survey asking orthopaedic surgeons about their opinions and attitudes concerning osteoporosis and hip arthroplasty. Adv Orthop 2016; 2016: 8079354. doi: 10.1155/2016/8079354. - DOI - PMC - PubMed
    1. Mueller L A, Nowak T E, Mueller L P, Schmidt R, Ehrmann C, Pitto R P, et al. . Acetabular cortical and cancellous bone density and radiolucent lines after cemented total hip arthroplasty: a prospective study using computed tomography and plain radiography. Arch Orthop Trauma Surg 2007; 127(10): 909-17. doi: 10.1007/s00402-007-0304-0. - DOI - PubMed
    1. Smolders J M, Pakvis D F, Hendrickx B W, Verdonschot N, van Susante J L. Periacetabular bone mineral density changes after resurfacing hip arthroplasty versus conventional total hip arthroplasty: a randomized controlled DEXA study. J Arthroplasty 2013; 28(7): 1177-84. doi: 10.1016/j.arth.2012.08.025. - DOI - PubMed