How shoulder replacement changes bone mineral density
Driven by the potential advantages of preserving bone stock and easier implant removal during revision surgery, the use of cementless short-stem implants in shoulder arthroplasty has increased in recent years. Despite this, joint replacement procedures outside the shoulder have reported postoperative bone loss in studies using dual-energy x-ray absorptiometry (DEXA) to measure bone density.
A recent study published in The Bone & Joint Journal has revealed changes in bone mineral density (BMD) around shoulder implants following total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA) procedures. Led by Dr. Katsumasa Nakazawa and Professor Hidetomi Terai at Osaka Metropolitan University's Graduate School of Medicine, the research utilized dual-energy x-ray absorptiometry (DEXA) to objectively measure bone density changes over the first two years post-surgery.
The study analyzed 137 patients, comparing BMD changes in the upper humeral area for 94 RSA patients and 43 aTSAs. The findings showed that RSA patients experienced significant decreases in BMD in certain regions around the implant stem, particularly in those with osteoporosis. In contrast, aTSA patients experienced a decline in BMD below the humeral head within the first six months, with little further decline thereafter.
The results suggest that osteoporosis before surgery, monitoring BMD post-surgery, and optimizing osteoporosis treatment may be crucial for improving long-term outcomes in RSA patients. These findings may also enhance preoperative evaluation and postoperative care for elderly patients undergoing shoulder arthroplasty, particularly those with osteoporosis undergoing RSA.
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