关节置换术后骨矿物质密度的变化：对不同解剖区域、固定技术和植入物设计的系统回顾

IF 2.7 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics Pub Date : 2025-05-20 DOI:10.1002/jeo2.70187

Domenico Alesi, Raffaele Zinno, Maria Scoppolini Massini, Giuseppe Barone, Davide Valente, Erika Pinelli, Stefano Zaffagnini, Agostino Igor Mirulla, Laura Bragonzoni

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引用次数: 0

摘要

目的本研究旨在评估不同种植体设计和固定技术的关节置换术后不同时间点的假体周围骨矿物质密度（BMD）。方法检索MEDLINE、Scopus、Cochrane Central Register of Controlled Trials、Web of Science和CINAHL数据库，检索2002年3月- 2024年1月期间关节置换术后骨重构的相关研究。入选标准：英文文章；全关节置换术；至少两次BMD评估；观察性研究、横断面、前瞻性、回顾性、随机对照试验和临床试验。排除标准：术后1个月内未测量骨密度；骨密度数据仅以百分比变化或图形表示，没有数值；髋关节置换术无格林区评价；膝关节置换术无假体周围骨评估；影响骨密度的药物治疗或合并症；翻修关节置换术；无关紧要的文章;无全文或无原始数据。结果68篇文章符合入选标准。55例集中在髋关节，12例集中在膝盖，1例集中在肩膀。全髋关节置换术后，股骨近端骨吸收最大，在6个月时达到峰值。骨水泥种植体和锥形茎比无骨水泥种植体和解剖茎表现出更大的骨吸收。髋臼组件周围的骨密度在前6个月下降，但在承受较高负荷的区域增加。在全膝关节置换术中，骨丢失发生在股骨远端前部和胫骨平台内侧，骨水泥和后稳定植入物比无骨水泥和保留十字架植入物的设计显示出更大的骨丢失。结论关节置换术后假体周围骨密度逐渐降低。固定技术和植入物的设计影响这种下降的程度和模式。这些因素必须在手术计划中考虑，因为它们可能对骨骼健康和种植体寿命有长期影响。需要进一步的研究来优化植入物的设计和手术技术，以减轻骨密度损失和改善患者的预后。证据等级四级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Variations in bone mineral density after joint replacement: A systematic review examining different anatomical regions, fixation techniques and implant design

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Variations in bone mineral density after joint replacement: A systematic review examining different anatomical regions, fixation techniques and implant design

Purpose

This study aims to evaluate postoperative periprosthetic bone mineral density (BMD) at various time points following joint replacement with different implant designs and fixation techniques.

Methods

Database search was conducted on MEDLINE, Scopus, Cochrane Central Register of Controlled Trials, Web of Science, and CINAHL for studies analyzing bone remodelling after joint replacement (March 2002–January 2024). Inclusion criteria: English-language articles; total joint replacement; at least two BMD evaluations; observational studies, cross-sectional, prospective, retrospective, randomised controlled trials, and clinical trials. Exclusion criteria: no BMD measurement within one month after surgery; BMD data only expressed as percentage changes or graphs without numerical values; no Gruen zone evaluation for hip replacement; no periprosthetic bone evaluation for knee replacement; pharmacological treatment or comorbidities affecting BMD; revision joint replacements; irrelevant articles; no full text or no original data.

Results

Sixty-eight articles matched the selection criteria. Fifty-five focused on the hip joint, 12 on the knee, and one on the shoulder. After total hip arthroplasty, the greatest bone resorption occurred in the proximal femur, peaking at 6 months. Cemented implants and tapered stems showed greater bone resorption than cementless implants and anatomical stems. BMD around the acetabular component decreased during the first 6 months but increased in regions subjected to higher loads. In total knee arthroplasty, bone loss occurred in the anterior distal femur and medial tibial plateau, with cemented and posterior-stabilised implants showing greater bone loss than cementless and cruciate-retaining designs.

Conclusions

The periprosthetic BMD decreases progressively after joint replacement. The fixation technique and implant design influence the extent and pattern of this decline. These factors must be considered during the surgical planning, as they can have long-term implications for bone health and implant longevity. Further research is needed to optimise implant design and surgical techniques to mitigate BMD loss and improve patient outcomes.