Osteoporosis does not increase the risk of periprosthetic fractures or aseptic loosening after cementless total hip arthroplasty.

Abstract

Osteoporosis and osteoarthritis often coexist in elderly THA patients, with up to 65 % showing low BMD. While osteoporosis is considered a risk for implant failure, its impact on cementless THA remains uncertain. This study examines whether osteoporosis increases the risk of periprosthetic fractures or aseptic loosening in cementless THA. A retrospective cohort study of 722 patients who underwent THA between 2019 and 2020 with follow-up through 2024 was conducted. Patients were stratified into two groups: with osteoporosis (n = 212) and without (n = 510). Data collected included demographics, fixation method, stem alignment, and postoperative complications. Revision cases were assessed for timing, cause, and Vancouver classification. Radiological findings (Gruen zones, stem subsidence) and early outcomes (transfusion, hospital stay) were evaluated. Follow-up extended up to 5 years. Demographics were comparable between groups, with no significant differences in age, sex, BMI, or lifestyle factors. The Charlson Comorbidity Index was slightly higher in osteoporotic patients (p = 0.050). Valgus stem alignment was more frequent in the osteoporosis group (p = 0.009), while neutral alignment was more common in non-osteoporotic patients (p = 0.007). No differences were found in varus alignment, radiolucencies, or cortical hypertrophy. Stem subsidence was lower in osteoporotic patients (p = 0.005); undersizing rates were similar. Early complications and length of stay showed no significant group differences. Osteoporosis alone should not be considered a contraindication to cementless THA. Our findings align with contemporary evidence that challenges the routine use of cemented stems solely based on BMD status.