Effect of Chronic Inflammation on Bone Density in Type 2 Diabetes Following Total Hip Arthroplasty.

Background: Patients with Type 2 Diabetes Mellitus (T2DM) constitute 20% of patients qualified for Total Hip Arthroplasty (THA). Poor glycemic control may result in a worse prognosis after THA. The aim of the study was to evaluate the effect of T2DM-induced inflammation on changes in bone density around the endoprosthesis stem in female patients.

Material and methods: The investigational group consisted of female patients with T2DM and HbA1c> 6.5% who underwent THA. A control group consisted of female patients with T2DM and HbA1c≤6.5% who underwent THA. Anthropometric measurements, laboratory testing and functional status assessment according to the Harris Hip Score (HSS) were performed. A DXA bone density scan was performed within the first day after THA. The measurements and assessments were repeated after one year.

Results: The Body Mass Index (BMI) was higher in the investigational group (33.802.93) than in the control group (31.223.40). Patients in the investigational group had higher CRP (4.661.59) as well as Bone Mineral Density (BMD) values in the operated (1.280.22) and opposite limb (0.940.14) on initial testing. After one year, there was a statistically significantly higher CRP in the investigational group (3.441.74) than in the control group (1.921.51).

Conclusions: 1. The level of HbA1c in patients with T2DM is not associated with periprosthetic changes in BMD. 2. BMD changes may be associated with chronic inflammation and may mask severe abnormalities in bone microarchitecture. 3. Patients with T2DM after THA should undergo long-term clinical follow-up.