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Factors influencing periprosthetic bone mineral density in total knee arthroplasty: a systematic review

  • Knee Arthroplasty
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Abstract

Introduction

Following total knee arthroplasty (TKA), there is a significant decline in periprosthetic bone mineral density (BMD), potentially resulting in complications such as prosthetic loosening, periprosthetic fracture, and influencing the postoperative recovery. The objective of this study was to summarize the factors influencing periprosthetic BMD in TKA from existing studies.

Methods

A comprehensive systematic search was performed in 4 databases: Pubmed, Embase, Web of Science, and Cochrane Library. The last search was carried out on October 12, 2023. We used the keywords ‘‘total knee arthroplasty’’, ‘‘bone mineral density’’ and each of them combined with ‘‘tibia’’ and ‘‘femur’’ to identify all relevant articles reporting about potential impact factors influencing the periprosthetic BMD in patients after TKA.

Results

Out of 1391 articles, 22 published from 2001 to 2023 were included in this systematic review. Following eligibility screening, six significant categories affecting periprosthetic BMD were recognized: prosthesis type, design of stem, coating, body weight, cement, and peg distance.

Conclusion

Mobile-bearing prostheses, modular polyethylene design, short stems, cruciform stems, avoidance of bone cement, higher body mass index, titanium nitride coating, and a smaller medial peg distance could potentially benefit periprosthetic BMD. Comprehensive consideration of diverse factors influencing periprosthetic BMD before surgery and collaboration with post-operative drug therapy are essential.

Trial registry: The PROSPERO registration number is CRD42023472030.

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Data availability

All data used in this systematic review were published in previous literature. Specifc information, on the data used or the analysis performed, is available upon request from the corresponding author.

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Acknowledgements

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Funding

This research was supported by Zhejiang Provincial Natural Science Foundation of China under Grant No. LD22C060002 and National Natural Science Foundation of China under Grant No. 82274547.

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Author notes

  1. Haojing Zhou and Lei Chen contributed equally to this work.

Authors and Affiliations

  1. Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China

    Haojing Zhou, Lei Chen, Hai Su & Yichen Gong

  2. The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang, China

    Guoqian Chen & Peijian Tong

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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Haojing Zhou and Lei Chen. The first draft of the manuscript was written by Haojing Zhou and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Guoqian Chen or Peijian Tong.

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Haojing Zhou, Lei Chen, Hai Su, Yichen Gong, Guoqian Chen, Peijian Tong declare that they have no conflict of interest.

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This systematic review did not require approval from the local medical research ethics committee.

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Zhou, H., Chen, L., Su, H. et al. Factors influencing periprosthetic bone mineral density in total knee arthroplasty: a systematic review. Arch Orthop Trauma Surg 144, 2273–2281 (2024). https://doi.org/10.1007/s00402-024-05308-3

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