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Effects of postoperative weight-bearing on body composition and bone mineral density after uncemented total hip arthroplasty
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
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2013 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 45, no 5, 498-503 p.Article in journal (Refereed) Published
Abstract [en]

Objective:

To investigate whether a postoperative weight-bearing regimen affects changes in bone mineral density and body composition after uncemented total hip arthroplasty, and to investigate the changes over a 5-year period after the surgical procedure.

Design:

Secondary analysis of a previous randomized controlled trial.

Methods:

A total of 39 patients were randomized to immediate full weight-bearing or partial weight-bearing for 3 months. Dual-energy X-ray absorptiometry was used to measure bone mineral density of the contralateral hip and both heels and to measure body composition.

Results:

The weight-bearing regimen had no effect on change in bone mineral density or body composition after 3 and 12 months. At 5 years, there was a decrease in bone mineral density of 3% in the total body and 2-3% in the contralateral hip regions. At 5 years we found a decrease in total body bone mineral content of 5%, but no changes in fat mass or lean mass compared with preoperative values.

Conclusion:

The postoperative weight-bearing regimen had no effect on changes in body composition or bone mineral density. Five years after total hip arthroplasty there was a decrease in bone mineral content and bone mineral density, but no changes in lean mass or fat mass.

Place, publisher, year, edition, pages
2013. Vol. 45, no 5, 498-503 p.
Keyword [en]
osteoarthritis of the hip; uncemented total hip arthroplasty; DXA; weight-bearing; body composition; bone mineral density
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-199774DOI: 10.2340/16501977-1140ISI: 000320345700012PubMedID: 23571688OAI: oai:DiVA.org:uu-199774DiVA: diva2:621170
Available from: 2013-05-14 Created: 2013-05-14 Last updated: 2017-12-06Bibliographically approved
In thesis
1. Osteoarthritis of the Hip and Uncemented Total Hip Arthroplasty: Effects of Immediate Weight Bearing on Implant Stability, Bone Mineral Density, and Body Composition
Open this publication in new window or tab >>Osteoarthritis of the Hip and Uncemented Total Hip Arthroplasty: Effects of Immediate Weight Bearing on Implant Stability, Bone Mineral Density, and Body Composition
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The initial recommendation for the postoperative regime after uncemented total hip arthroplasty (THA) was 6-12 weeks of partial weight bearing (PWB) to obtain a stable implant position during bone ingrowth. In recent years patients with uncemented THA have increasingly practiced full weight bearing (FWB) after surgery, which has largely been based on clinical experience rather than on scientific evidence. The aim of this thesis was to investigate the effects of FWB versus PWB for 3 months on the stability of the implants and on bone mineral density (BMD), as well as body composition (BC) of the lower extremities.

We used radiostereometric analysis (RSA) to measure implant micromotion and dual X-ray absorptiometry (DXA) to measure BMD and BC. Forty-six patients with strictly unilateral osteoarthritis of the hip (OAH) received uncemented THA. These patients were then randomized to the FWB or PWB groups and followed for 5 years.

In a preoperative cross-sectional study the BMD of the hip and heel were compared between the OAH-affected side and the healthy side. The study showed an increase of BMD at the femoral neck and a decrease at the total hip and trochanter. The results of a RSA study of cup stability showed that there might be minimal movement in medial and proximal directions during the first postoperative week. These results indicate that the RSA baseline investigation of uncemented cups should be performed as early as possible after the first postoperative day. FWB had no adverse effects on the stability of the uncemented press-fit cups or the uncemented cementless Spotorno (CLS) femoral stems after a 5-year follow-up. There was no difference in periprosthetic BMD around the CLS stem regardless of the postoperative weight bearing regime. All zones around the femoral stem indicated a recovery in BMD toward baselines, except the calcar region, which showed progressive loss in BMD to -22% at 5 years post-surgery. FWB had no effect on the changes in BC after surgery.

In conclusion, FWB is safe in uncemented THA in terms of stability, BMD and BC. Furthermore, THA apparently counteracts age-related changes in BC but not in BMD.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2010. 72 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 600
Keyword
Osteoarthritis of the hip, uncemented, total hip arthroplasty, stability, RSA, BMD, DXA, body composition, weight bearing
National Category
Surgery
Research subject
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-131092 (URN)978-91-554-7899-5 (ISBN)
Public defence
2010-11-05, Grönwallsalen, Akademiska sjukhuset, ingång 70, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2010-10-15 Created: 2010-09-22 Last updated: 2013-08-16Bibliographically approved

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Wolf, OlofMattsson, PerMilbrink, JanLarsson, SuneMallmin, Hans

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