Resurfacing total hip replacement–a therapeutical approach in postmenopausal women with osteoporosis and hip arthrosis

Aim: Patients with incipient hip arthrosis may benefit from a relatively new therapeutical approach using resurfacing total hip replacement, but in those with associated osteoporosis, this type of surgical intervention is contraindicated, given the poor quality of osteoporotic bones. We assessed the efficacy of the antiosteoporotic pharmacological therapy to improve bone quality and bone strength in postmenopausal women diagnosed with hip arthrosis and osteoporosis thus facilitating the hip surgical intervention. Methods: We evaluated 20 postmenopausal women aged between 53–60 years diagnosed with osteoporosis according to the WHO criteria, by using dual–energy X–ray absorptiometry (DXA) for bone mineral density measurements. All these patients had low hip T score (osteopenia/ osteoporosis) and also incipient hip arthrosis. The surgical approach was delayed for 12 months and all the patients received bisphosphonate therapy with calcium and vitamin D supplements. DXA scans were performed after 12 months of therapy in all the patients. Results: A surgical intervention with resurfacing total hip replacement was performed in 12 of the 16 patients presenting with increasing BMD, 4 of them showing elements of rapidly advancing hip arthrosis to a stage that made this type of intervention impossible. We chose not to use this technique in the group with stable BMD (4 patients). All 12 women surgically treated had a favorable post–operative outcome without experiencing a femoral neck fracture during the surgical intervention or during the twelve–month follow–up. All 20 patients continued to receive bisphosphonate therapy. Conclusion: In postmenopausal women with osteoporosis and associated hip arthrosis, improving bone mass and bone quality with bisphosphonate therapy is necessary and important in order to allow hip arthroplasty, by using the technique of resurfacing, avoiding the risk of intra–operative fractures and with a favorable post–operative long–term outcome.