OSTEOPOROSIS AND JOINT REPLACEMENT

Over the past few decades, the number of implantation of endoprosthetic joint replacements has steadily increased. Many patients who need joint replacements are of older age and have a reduced bone quality due to osteoporosis. In patients with joint replacements and osteoporosis complications are often seen: intraoperative periprosthetic fractures, periprosthetic osteolysis, increased implant migration or postoperative periprosthetic fractures. The evaluation of bone quality therefore seems an essential point in patient management to provide the best possible care and to optimize long term surgical outcomes. If necessary, patients should be educated about a possible calcium and vitamin D supplementation. In addition, it seems reasonable to aim for physiological vitamin D levels perioperatively. In postmenopausal women, men over 70 years and both women and men with an increased risk of osteoporosis within two years of implantation of a total joint replacement a bone mineral density measurement should be performed. In patients with reduced bone quality, treatment with bisphosphonates, denosumab or teriparatide should be considered in order to improve the osseous integration of cementless implants, to increase the lifespan of implants as well as to reduce periprosthetic fractures and fractures in general. In individual cases of patients with osteoporosis cementation of prosthetic components (especially in total hip replacements) may be required

The Most Cited Papers in Osteoporosis and Related Research

Osteoporosis is a systemic disease of the bone that affects millions of people and causes burden for both the affected individual and health systems and societies worldwide. Since the 1970s much research has been done in the field of osteoporosis. The number of citations of a paper reflects its influence and importance to the field. Thomson ISI Web of Science database was searched to retrieve a list of the fifty most cited articles related to osteoporosis and its research. The fifty most cited articles in absolute numbers in the field of osteoporosis were cited from 877 to 3056 times (mean 1141±537). Most papers were published in the basic science category (n=23). 395 authors contributed; a single paper had between one and 62 authors (mean: 10.02±9.9 authors). 12 authors (3.04%) contributed between 7 and 4 papers; 340 authors (86.1%) were at least named once. Corresponding authors were from eight countries with most contributions from the United States (n=34, 68%). The majority of papers were published in the 1990s (n=29). The list of 50 most cited papers presents citation classics in the field of osteoporosis and related research

SUBCHONDRAL BONE IN OSTEOARTHRITIS OF THE KNEE

Subchondral bone changes seem to contribute to the progression of knee osteoarthritis (OA). The study aimed to analyze subchondral bone microstructure in specimens of late-stage knee OA in respect to articular cartilage damage, meniscus integrity and knee joint alignment. Methods and Materials: 30 proximal tibiae of 30 patients (20 female and 10 male) with late-stage OA retrieved during total knee arthroplasty (TKA) were scanned using a high-resolution MicroComputed Tomography (μCT). The scans were semi-automatically segmented into five volumes of interest (VOIs). The VOIs were than further analyzed using commercially available software. The degree of articular cartilage damage was assessed semi-quantitatively by magnetic resonance imaging (MRI) before surgery. Results: The mean bone fraction volume (BV/TV) in all weight bearing locations was significantly higher compared to the non weight-bearing reference point below the anterior cruciate ligament (p=0,000). The mean BV/TV in the medial compartment was significantly higher compared to the lateral compartment (p=0,007). The BV/TV in intact menisci, there was a significantly lower subchondral BV/TV compared to subluxated or luxated menisci in the medial (p=0,020) and lateral compartment (p=0,005). Varus alignment had a significantly higher subchondral BV/TV in the medial compartment, whereas valgus alignment had a significantly higher subchondral BV/TV in the lateral compartment (p=0,011). Conclusion: The results show significant differences of subchondral bone microstructural parameters in respect to cartilage damage, meniscus’ structural integrity and knee joint alignment. Therefore, subchondral bone changes seem to be a secondary process in the late-stage OA of knee caused by mechanical changes

Evaluation of FRAX in patients with periprosthetic fractures following primary total hip and knee arthroplasty

Abstract The fracture risk assessment tool (FRAX) is a tool which calculates an individual 10-year fracture risk based on epidemiological data in patients with a risk of osteporosis. The aim of this study was to evaluate the value of FRAX to estimate the risk of postoperative periprosthetic fractures (PPF) in patients following with total hip and knee arthroplasty. 167 patients (137 periprosthetic fractures in total hip arthroplasty and 30 periprosthetic fractures in total knee arthroplasty) were included in this study. Patients’ data was retrieved retrospectively. In each patient the 10-year probability of a major osteoporotic fracture (MOF) and an osteoporotic hip fracture (HF) was calculated using FRAX. According to the NOGG guideline 57% of total hip arthroplasty (THA) patients and 43.3% of total knee arthroplasty (TKA) patients were in need of osteoporosis treatment, whereas only 8% and 7% received an adequate one respectively. 56% of the patients with PPF after THA and 57% of the patients with PPF after TKA reported about a previous fracture. Significant associations between the 10-year probability of a MOF and HF calculated by FRAX and PPF in THA and TKA were seen. The results of the present study show that FRAX might have the potential to estimate the PPF in patients following THA and TKA. FRAX should be calculated before and after THA or TKA in order to assess the risk and counsel patients. The data show a clear undertreatment of patients with PPF in respect to osteoporosis

Body image and self-esteem in lower-limb amputees.

BACKGROUND: Limb amputation is often an inevitable procedure in the advanced condition of various diseases and poses a dramatic impact on a patient's life. The aim of the present study is to analyze the impact of lower-limb amputations on aesthetic factors such as body image and self-esteem as well as quality of life (QoL). METHODS: 298 patients (149 uni- or bilateral lower-limb amputees and 149 controls) were included in this cross-sectional study in three centers. Demographic data was collected and patients received a 118-item questionnaire including the Multidimensional Body-Self Relations Questionnaire (MBSRQ), the Rosenberg Self-esteem (RSE) scale and the SF-36 Health Survey (QoL). ANOVA and student's t-test were used for statistical analysis. RESULTS: Unilateral lower-limb amputees showed a significant lower MBSRQ score of 3.07±0.54 compared with 3.41±0.34 in controls (p<0.001) and a lower score in the RSE compared to controls (21.63±4.72 vs. 21.46±5.86). However, differences were not statistically significant (p = 0.36). Patients with phantom pain sensation had a significantly reduced RSE (p = 0.01). The SF-36 health survey was significantly lower in patients with lower-limb amputation compared to controls (42.17±14.47 vs. 64.05±12.39) (p<0.001). CONCLUSION: This study showed that lower-limb amputations significantly influence patients' body image and QoL. Self-esteem seems to be an independent aspect, which is not affected by lower-limb amputation. However, self-esteem is influenced significantly by phantom pain sensation

Outcome parameters in orthogeriatric co-management - a mini-review

Recognizing hip and other fragility fractures as an adverse event of chronic geriatric conditions led to the concept of orthogeriatric co-management (OGC). OGC today represents various forms of structural cooperation between orthopedic trauma surgeons and multiprofessional geriatric teams taking care of frail elderly patients. The models are country specific. Despite several published models there are still no clear recommendations on how this service should be best organized. The 12 outcome parameters published by the Experts' Roundtable in 2013 were recommended to be used for the further assessment of different OCG models. This literature review was prepared accordingly and showed the need for further studies to determine the best OGC model and to define a uniform set of outcome parameters for use in future clinical studies

Result of the SF-36 - QOL in unilateral lower-limb amputees and controls.

<p>Box plot showing the distribution of the SF-36 in unilateral lower-limb amputees (left) and controls (right). Horizontal red lines indicate medians; blue boxes specify inter-quartile ranges and dashed lines the ranges without outliers.</p