Long-term periprosthetic femoral bone loss after cementless total hip arthroplasty: natural history and response to late osteoporosis treatment

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Abstract
The long-term course of periprosthetic bone mineral density (BMD) after cementless total hip arthroplasty (THA) and BMD changes during late osteoporosis treatment remain unclear. Fifty-eight hips in 44 patients underwent dual-energy X-ray absorptiometry (DXA) > 15 years after cementless THA using a proximally coated tapered stem. Longitudinal changes were assessed in 18 hips (12 patients) with serial DXA obtained within three months, at one year, and at a mean of 17.2 years postoperatively. For therapeutic analysis, ten hips (7 patients) with osteoporosis received zoledronic acid annually, together with daily eldecalcitol and calcium, for two years with serial DXA before treatment and during follow-up. At a mean of 17.2 years, lumbar spine BMD declined to 74.9% of baseline (P < 0.001 vs 1 year). Zones 3-5 showed similar reductions (all P > 0.05, vs lumbar spine). In contrast, proximal zones 1, 2, 6, and 7 showed significantly greater reductions (60.0%, 61.8%, 54.0%, and 30.8%, respectively; all P < 0.001 vs lumbar spine), with zone 7 demonstrating the greatest decrease. During osteoporosis treatment, lumbar spine BMD increased to 107.8% of pretreatment values at two years (P = 0.004). No statistically significant change in periprosthetic BMD was detected, although only zone 5 showed a significant increase (P = 0.014). Proximal periprosthetic bone loss was evident beyond 15 years after cementless THA, with the greatest reduction in Zone 7. Late osteoporosis treatment was associated with no significant further decline in periprosthetic BMD but did not reverse severe proximal bone loss.

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