Download PDF
Arthritis und Rheuma 2025; 45(01): 21-24
DOI: 10.1055/a-2438-8832
Schwerpunkt

Hüftendoprothetik bei Osteoporose

Andreas Niemeier
Klinik für Orthopädie und Unfallchirurgie, Krankenhaus Reinbek, St. Adolf-Stift, Reinbek
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Zusammenfassung

Osteoporose stellt sowohl bei Frakturprothesen der Hüfte als auch bei elektiven Hüftprothesen eine prävalente und relevante Komorbidität dar. Nahezu 100 % aller Patienten, die wegen einer Fragilitätsfraktur des proximalen Femurs eine Hüftendoprothese erhalten und etwa 30 % aller Patienten, die eine elektive Hüftendoprothese implantiert bekommen, weisen eine manifeste, medikamentös behandlungsbedürftige Osteoporose auf. Die demografische Entwicklung in der EU hat eine deutliche Zunahme sowohl der Coxarthroseprävalenz als auch der Osteoporoseprävalenz zur Folge. Trotzdem wird weiterhin ein Großteil (> 50 %) der Patienten mit behandlungsflichtiger Osteoporose in den meisten europäischen Ländern selbst nach eingetretener Fragilitätsfraktur nicht adäquat therapiert. Es ist wesentlich, die Osteoporose als Risikofaktor für intra- und postoperative periprothetische Frakturen und für aseptische Prothesenlockerungen zu erkennen. Ab dem 75. Lebensjahr besteht bei Verwendung zementfreier Schäfte ein signifikant erhöhtes Revisionsrisiko im Vergleich zu zementierten Schäften. Osteoporosescreening und -therapie sollte daher Bestandteil des Behandlungsalgorithmus im Rahmen der Hüftendoprothetik des älteren Menschen sein.

Schlüsselwörter

Osteoporose - Hüftendoprothetik


Publication History

Article published online:
26 February 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

  • Literatur

  • 1 Delsmann MM, Strahl A, Mühlenfeld M. et al. High prevalence and undertreatment of osteoporosis in elderly patients undergoing total hip arthroplasty. Osteoporos Int 2021; 32 (8) 1661-1668
    CrossrefPubMedSearch in Google Scholar
  • 2 Lingard EA, Mitchell SY, Francis RM. et al. The prevalence of osteoporosis in patients with severe hip and knee osteoarthritis awaiting joint arthroplasty. Age Ageing 2010; 39 (2) 234-239
    CrossrefPubMedSearch in Google Scholar
  • 3 Labuda A, Papaioannou A, Pritchard J. et al. Prevalence of osteoporosis in osteoarthritic patients undergoing total hip or total knee arthroplasty. Arch Phys Med Rehabil 2008; 89 (12) 2373-2374
    CrossrefPubMedSearch in Google Scholar
  • 4 Makinen TJ, Alm JJ, Laine H. et al. The incidence of osteopenia and osteoporosis in women with hip osteoarthritis scheduled for cementless total joint replacement. Bone 2007; 40: 1041-1047
    CrossrefPubMedSearch in Google Scholar
  • 5 Glowacki J, Hurwitz S, Thornhill TS. et al. Osteoporosis and vitamin-D deficiency among postmenopausal women with osteoarthritis undergoing total hip arthroplasty. J Bone Joint Surg Am 2003; 85-A: 2371-2377
    CrossrefPubMedSearch in Google Scholar
  • 6 Kanis JA, Johnell O, Oden A. et al. Risk of hip fracture according to the World Health Organization criteria for osteopenia and osteoporosis. Bone 2000; 27: 585-590
    CrossrefPubMedSearch in Google Scholar
  • 7 Kanis JA, Melton III LJ, Christiansen C. et al. The diagnosis of osteoporosis. J Bone Miner Res 1994; 9: 1137-1141
    CrossrefPubMedSearch in Google Scholar
  • 8 Bernatz JT, Brooks AE, Squire MW. et al. Osteoporosis Is Common and Undertreated Prior to Total Joint Arthroplasty. J Arthroplasty 2019; 34 (7) 1347-1353
    CrossrefPubMedSearch in Google Scholar
  • 9 Ogino D, Kawaji H, Konttinen L. et al. Total hip replacement in patients eighty years of age and older. J Bone Joint Surg Am 2008; 90: 1884-1890
    CrossrefPubMedSearch in Google Scholar
  • 10 Dale H, Børsheim S, Kristensen TB. et al. Fixation, sex, and age: highest risk of revision for uncemented stems in elderly women – data from 66,995 primary total hip arthroplasties in the Norwegian Arthroplasty Register. Acta Orthop 2020; 91 (1) 33-41
    CrossrefPubMedSearch in Google Scholar
  • 11 Bunyoz KI, Malchau E, Malchau H, Troelsen A. Has the Use of Fixation Techniques in THA Changed in This Decade? The Uncemented Paradox Revisited. Clin Orthop Relat Res 2020; 478 (4) 697-704
    CrossrefPubMedSearch in Google Scholar
  • 12 Bloemheuvel EM, van Steenbergen Liza N, Swierstra BA. Comparable mortality but higher revision rate after uncemented compared with cemented total hip arthroplasties in patients 80 years and older: report of 43,053 cases of the Dutch Arthroplasty Register. Acta Orthopaedica 2022; 93: 151-157
    CrossrefPubMedSearch in Google Scholar
  • 13 Australian Orthopaedic Association National Joint Replacement Registry. Annual Report 2021. Im Internet: Accessed December 18, 2024 at: https://aoanjrr.sahmri.com/annual-reports-2021
  • 14 Tanzer M, Graves SE, Peng A. et al. Is Cemented or Cementless Femoral Stem Fixation More Durable in Patients Older Than 75 Years of Age? A Comparison of the Best-performing Stems. Clin Orthop Relat Res 2018; 476 (7) 1428-1437
    CrossrefPubMedSearch in Google Scholar
  • 15 Edelstein AI, Hume EL, Pezzin LE. et al. The Impact of Femoral Component Cementation on Fracture and Mortality Risk in Elective Total Hip Arthroplasty: Analysis from a National Medicare Sample. J Bone Joint Surg Am 2022; 104 (6) 523-529
    CrossrefPubMedSearch in Google Scholar
  • 16 Hooper GJ, Rothwell AG, Stringer M. et al. Revision following cemented and uncemented primary total hip replacement: a seven-year analysis from the New Zealand Joint Registry. J Bone Joint Surg Br 2009; 91 (4) 451-458
    CrossrefPubMedSearch in Google Scholar
  • 17 Endoprothesenregister Deutschland. Im Internet: Accessed December 18, 2024 at: https://www.eprd.de
  • 18 Abdel MP, Watts CD, Houdek MT. et al. Epidemiology of periprosthetic fracture of the femur in 32.644 primary total hip arthroplasties: a 40-year experience. Bone Joint J 2016; 98-B (4) 461-467
    CrossrefPubMedSearch in Google Scholar
  • 19 Gromov K, Bersang A, Nielsen CS. et al. Risk factors for post-operative periprosthetic fractures following primary total hip arthroplasty with a proximally coated double-tapered cementless femoral component. Bone Joint J 2017; 99-B (4) 451-457
    CrossrefPubMedSearch in Google Scholar
  • 20 Lamb JN, Baetz J, Messer-Hannemann P. et al. A calcar collar is protective against early periprosthetic femoral fracture around cementless femoral components in primary total hip arthroplasty: a registry study with biomechanical validation. Bone Joint J 2019; 101-B (7) 779-786
    CrossrefPubMedSearch in Google Scholar
  • 21 Johnson AJ, Desai S, Zhang C. et al. A Calcar Collar Is Protective Against Early Torsional/Spiral Periprosthetic Femoral Fracture: A Paired Cadaveric Biomechanical Analysis. J Bone Joint Surg Am 2020; 102 (16) 1427-1433
    CrossrefPubMedSearch in Google Scholar
  • 22 Lindberg-Larsen M, Jørgensen CC, Solgaard S. et al. Lunbeck Foundation Centre for Fast-track Hip and Knee Replacement. Increased risk of intraoperative and early postoperative periprosthetic femoral fracture with uncemented stems. Acta Orthop 2017; 88 (4) 390-394
    CrossrefPubMedSearch in Google Scholar
  • 23 Liu B, Ma W, Li H. et al. Incidence, Classification, and Risk Factors for Intraoperative Periprosthetic Femoral Fractures in Patients Undergoing Total Hip Arthroplasty With a Single Stem: A Retrospective Study. J Arthroplasty 2019; 34 (7) 1400-1411
    CrossrefPubMedSearch in Google Scholar
  • 24 Venesmaa PK, Kroger HP, Miettinen HJ. et al. Alendronate reduces periprosthetic bone loss after uncemented primary total hip arthroplasty: a prospective randomized study. J Bone Miner Res 2001; 16: 2126-2131
    CrossrefPubMedSearch in Google Scholar
  • 25 Wilkinson JM, Stockley I, Peel NF. et al. Effect of pamidronate in preventing local bone loss after total hip arthroplasty: a randomized, double-blind, controlled trial. J Bone Miner Res 2001; 16: 556-564
    CrossrefPubMedSearch in Google Scholar
  • 26 Hennigs T, Arabmotlagh M, Schwarz A. et al. Dose-dependent prevention of early periprosthetic bone loss by alendronate. Z Orthop Ihre Grenzgeb 2002; 140: 42-47
    PubMedSearch in Google Scholar
  • 27 Bhandari M, Bajammal S, Guyatt GH. et al. Effect of bisphosphonates on periprosthetic bone mineral density after total joint arthroplasty. A meta-analysis. J Bone Joint Surg Am 2005; 87: 293-301
    CrossrefPubMedSearch in Google Scholar
  • 28 Arabmotlagh M, Rittmeister M, Hennigs T. Alendronate prevents femoral periprosthetic bone loss following total hip arthroplasty: prospective randomized double-blind study. J Orthop Res 2006; 24: 1336-1341
    CrossrefPubMedSearch in Google Scholar
  • 29 Kinov P, Tivchev P, Doukova P. et al. Effect of risedronate on bone metabolism after total hip arthroplasty: a prospective randomised study. Acta Orthop Belg 2006; 72: 44-50
    PubMedSearch in Google Scholar
  • 30 Nishioka T, Yagi S, Mitsuhashi T. et al. Alendronate inhibits periprosthetic bone loss around uncemented femoral components. J Bone Miner Metab 2007; 25: 179-183
    CrossrefPubMedSearch in Google Scholar
  • 31 Yamasaki S, Masuhara K, Yamaguchi K. et al. Risedronate reduces postoperative bone resorption after cementless total hip arthroplasty. Osteoporos Int 2007; 18: 1009-1015
    CrossrefPubMedSearch in Google Scholar
  • 32 Shi J, Liang G, Huang R. et al. Effects of bisphosphonates in preventing periprosthetic bone loss following total hip arthroplasty: a systematic review and meta-analysis. J Orthop Surg Res 2018; 13: 225
    CrossrefPubMedSearch in Google Scholar
  • 33 Aro HT, Nazari-Farsani S, Vuopio M. et al. Effect of denosumab on femoral periprosthetic BMD and early femoral stem subsidence in postmenopausal women undergoing cementless total hip arthroplasty. JBMR Plus 2019; 3: e10217
    CrossrefPubMedSearch in Google Scholar
  • 34 Arabmotlagh M, Pilz M, Warzecha J. et al. Changes of femoral periprosthetic bone mineral density 6 years after treatment with alendronate following total hip arthroplasty. J Orthop Res 2009; 27: 183-188
    CrossrefPubMedSearch in Google Scholar
  • 35 Kobayashi N, Inaba Y, Uchiyama M. et al. Teriparatide versus alendronate for the preservation of bone mineral density after total hip arthroplasty – a randomized controlled trial. J Arthroplasty 2016; 31: 333-338
    CrossrefPubMedSearch in Google Scholar
  • 36 Teng S, Yi C, Krettek C. et al. Bisphosphonate Use and Risk of Implant Revision after Total Hip/Knee Arthroplasty: A Meta-Analysis of Observational Studies. PLoS One 2015; 10 (10) e0139927
    CrossrefPubMedSearch in Google Scholar
  • 37 Ro DH, Jin H, Park JY. et al. The use of bisphosphonates after joint arthroplasty is associated with lower implant revision rate. Knee Surg Sports Traumatol Arthrosc 2019; 27 (7) 2082-2089
    CrossrefPubMedSearch in Google Scholar