Peculiarities of total hip arthroplasty in patients with low bone mass

Background: Total hip arthroplasty (THA) is frequently performed in elderly populations where the prevalence of systemic bone loss is high. Despite the clinical success of THA, the impact of undiagnosed osteoporosis and osteopenia on implant stability remains a significant concern, as these conditions may be underestimated due to infrequent preoperative bone mineral density (BMD) screening.

Objective: This review aims to evaluate the incidence of low bone mass in THA candidates, analyze the patterns of periprosthetic bone remodeling, and examine the efficacy of modern uncemented acetabular components in patients with compromised bone quality.

Key Points: Research indicates that 21–32% of patients with severe osteoarthritis also have osteoporosis. Low BMD is associated with increased migration of uncemented components and higher risks of intraoperative periprosthetic fractures. Postoperative bone remodeling studies show significant BMD reductions in Gruen zone 7 and periacetabular regions within the first three years. While porous tantalum and titanium implants are designed to enhance biological fixation through biomimetic porosity and low Young’s modulus, their performance in osteoporotic bone is less understood. Increased bone resorption and proinflammatory cytokines in these patients may elevate implant micromobility beyond the 150μm threshold, potentially leading to fibrous tissue formation instead of osseointegration.

Conclusion: Low bone mass significantly influences both intraoperative risks and long-term implant survivorship. Although highly porous acetabular designs offer theoretical advantages for biological fixation, further clinical and experimental studies are required to establish definitive protocols for managing THA in patients with reduced BMD.