Restoration of proximal periprosthetic bone loss by denosumab in cementless total hip arthroplasty

  • Satoshi Nagoya
  • Kenji Tateda
  • Shunichiro Okazaki
  • Ima Kosukegawa
  • Junya Shimizu
  • Toshihiko Yamashita
Original Article • HIP - ARTHROPLASTY



Denosumab contributed to the restoration of proximal periprosthetic bone loss around the femoral stem that were measured using a DEXA, especially in zone 7, at 1 year after cementless THA in elderly osteoporotic patients.


Although bone quality is an important issue in elderly osteoporotic patients who underwent total hip arthroplasty (THA) with a cementless stem, periprosthetic bone mineral density (BMD) in the proximal femur has been reported to be decreased by 15–40% postoperatively. Some authors have examined the use of several types of bisphosphonates to prevent decreases in BMD in the proximal femur after cementless THA; however, few reports have demonstrated success in restoring BMD in the proximal medial femoral bone, such as zone 7.


We conducted prospective study comparing patients who underwent cementless THA administered with denosumab (10 patients) and without denosumab (10 patients). BMD around the femoral stem were measured using a DEXA immediately after surgery, and at 6 months and at 1 year after surgery. No difference was found between the two groups referred to the patient’s demographic data.


We found that denosumab displayed definitive effects in increasing the % change in periprosthetic BMD at zone 7 by an average of 7.3% in patients with cementless THA, compared to control group who were given only vitamin D.


Denosumab is one of a number of anti-osteoporotic agents to have a definitive effect on the restoration of proximal periprosthetic bone loss, especially in zone 7, after cementless THA. Denosumab contributed to the restoration of decreased periprosthetic BMD to normal levels. As the decrease in BMD in the proximal femur after THA is considered to be apparent at 6–12 months after surgery, it is believed that prevention of the deterioration of bone quality is important in the proximal femur immediately after cementless THA for elderly female patients with osteoporosis.


Total hip arthroplasty Bone mineral density Femoral bone atrophy Denosumab Stress shielding 


Compliance with ethical standards

Conflict of interest

Satoshi Nagoya declares that he occupies an endowed chair funded by ZimmerBiomet and Smith & Nephew. Kenji Tateda, Shunichiro Okazaki, Ima Kosukegawa, Junya Shimizu and Toshihiko Yamashita declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Musculoskeletal Biomechanics and Surgical DevelopmentSapporo Medical UniversitySapporoJapan
  2. 2.Department of Orthopedic SurgerySapporo Medical UniversitySapporoJapan

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