Total knee arthroplasty and periprosthetic distal femoral fracture: looking beyond the osteoporosis to previous osteoporotic fracture.

IF 4.2 2区医学 Q1 ENDOCRINOLOGY & METABOLISM Osteoporosis International Pub Date : 2024-08-01 Epub Date: 2024-05-27 DOI:10.1007/s00198-024-07138-w

Y-B Park, M Kim, H-C Nam, J-W Jeon, C-W Ha

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Abstract

Osteoporosis increases the risk of periprosthetic distal femoral fractures after TKA, especially in patients with a history of osteoporotic fractures. Therefore, careful assessment and proper treatment of osteoporosis need and the importance of taking osteoporotic medication needs to be recognized by the patients following primary TKA.

Purpose: Osteoporosis is a risk factor for fractures, including those of the hip, vertebrae, and distal radius; however, the association between osteoporosis and periprosthetic fractures after total knee arthroplasty (TKA) has not been much investigated. Therefore, we aimed to investigate the association of the presence of systemic osteoporosis with periprosthetic fractures after TKA.

Methods: This study included 34 patients with periprosthetic fractures following primary TKA and 106 controls matched for age and sex. Bone mineral density was evaluated at the femoral neck, total hip, and lumbar spine using dual X-ray absorptiometry. Medical records were reviewed for age; sex; body mass index; smoking; rheumatoid arthritis, endocrine diseases, and cardiovascular diseases; history of glucocorticoid use; medication for osteoporosis; and history of previous osteoporotic fracture. In addition, anterior femoral notching after TKA was evaluated. Univariable and multivariable logistic regression analysis were used to determine factors associated with periprosthetic fracture.

Results: The prevalence of osteoporosis in the fracture group was higher than that in the control group (61.8% vs. 40.6%, p=0.045). The rate of medication for osteoporosis was significantly low in the fracture group (47.6 % vs 76.7%, p=0.026). History of previous osteoporotic fracture (odds ratio [OR], 9.1; p=0.015) and osteoporosis (OR, 3.6; p=0.013) were significant risk factors for periprosthetic fractures after TKA. Medication for osteoporosis could decrease the risk of periprosthetic fracture (OR 0.3; p=0.020).

Conclusion: Osteoporosis is a major risk factor for periprosthetic distal femoral fractures after TKA. Therefore, careful assessment and proper treatment of osteoporosis need and the importance of taking osteoporotic medication needs to be recognized to the patients following primary TKA, especially in patients with a history of osteoporotic fracture.

Level of evidence: Prognostic study, level III.

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全膝关节置换术与股骨远端假体周围骨折：从骨质疏松症到先前的骨质疏松性骨折。

骨质疏松症会增加TKA术后发生股骨远端假体周围骨折的风险，尤其是在有骨质疏松性骨折病史的患者中。目的：骨质疏松症是骨折（包括髋部、椎骨和桡骨远端骨折）的危险因素之一，但骨质疏松症与全膝关节置换术（TKA）后假体周围骨折之间的关系尚未得到广泛研究。因此，我们旨在研究全身性骨质疏松症与 TKA 术后假体周围骨折的关系：本研究纳入了 34 名原发性 TKA 术后假体周围骨折患者和 106 名年龄和性别匹配的对照组。采用双 X 射线吸收测量法评估股骨颈、全髋和腰椎的骨质密度。病历审查包括年龄、性别、体重指数、吸烟、类风湿性关节炎、内分泌疾病和心血管疾病、糖皮质激素使用史、骨质疏松症药物治疗史和既往骨质疏松性骨折史。此外，还对TKA术后股骨前切迹进行了评估。采用单变量和多变量逻辑回归分析确定与假体周围骨折相关的因素：骨折组的骨质疏松症患病率高于对照组（61.8% 对 40.6%，P=0.045）。骨折组骨质疏松症用药率明显较低（47.6% 对 76.7%，P=0.026）。既往骨质疏松性骨折史（几率比 [OR]，9.1；P=0.015）和骨质疏松症（OR，3.6；P=0.013）是 TKA 术后假体周围骨折的重要风险因素。治疗骨质疏松症的药物可降低假体周围骨折的风险（OR 0.3；P=0.020）：结论：骨质疏松症是导致 TKA 术后股骨远端假体周围骨折的主要风险因素。结论：骨质疏松症是 TKA 术后股骨远端假体周围骨折的主要危险因素，因此，需要对骨质疏松症进行仔细评估和适当治疗，并认识到服用骨质疏松症药物的重要性，尤其是对有骨质疏松性骨折病史的患者：预后研究，III 级。

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来源期刊

Osteoporosis International 医学-内分泌学与代谢

CiteScore

8.10

自引率

10.00%

发文量

224

审稿时长

3 months

期刊介绍： An international multi-disciplinary journal which is a joint initiative between the International Osteoporosis Foundation and the National Osteoporosis Foundation of the USA, Osteoporosis International provides a forum for the communication and exchange of current ideas concerning the diagnosis, prevention, treatment and management of osteoporosis and other metabolic bone diseases. It publishes: original papers - reporting progress and results in all areas of osteoporosis and its related fields; review articles - reflecting the present state of knowledge in special areas of summarizing limited themes in which discussion has led to clearly defined conclusions; educational articles - giving information on the progress of a topic of particular interest; case reports - of uncommon or interesting presentations of the condition. While focusing on clinical research, the Journal will also accept submissions on more basic aspects of research, where they are considered by the editors to be relevant to the human disease spectrum.