Stress bone remodeling after endoprosthetic replacement of large joints and its conservative correction

Abstract

Arthroplasty is stated to be one of the most effective surgical treatments for rheumatic diseases (RD). However, the problem is that the bad quality of bone tissue has a negative impact on the outcome of surgery. The authors have studied the time course of changes in bone mineral density (BMD) after total hip arthroplasty in 81 patients with RD. All the patients underwent dual-energy X-ray densitometry by a special orthopedic program. BMD was measured in 7 areas of a femoral prosthetic component as described by T.A. Gruen et al. and that was in 3 areas of an acetabular component as proposed by J.L. DeLee и J. Charnley. The first (initial) measurement was carried out a fortnight after surgery; later measurements were made following 3, 6, and 12 months. It was established that there was a progressive BMD loss after surgery; following 3 months all the areas virtually exhibited a BMD reduction that peaked by month 6. BMD loss around the endoprosthetic acetabular component was about 20 %. The use of bisphosphonates, such as ibandronate (Bonviva), one of the most potent drugs of this group, is shown to be most promising in preventing BMD loss around the prosthesis.