Evidence map›Paper›PMID 40401156›Full record

ReviewJournal of experimental orthopaedics2025

Variations in bone mineral density after joint replacement: A systematic review examining different anatomical regions, fixation techniques and implant design.

Domenico Alesi, Raffaele Zinno, Maria Scoppolini Massini, Giuseppe Barone, Davide Valente, Erika Pinelli, Stefano Zaffagnini, Agostino Igor Mirulla, Laura Bragonzoni

Abstract readReview
In one paragraph

Review in Journal of experimental orthopaedics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Review
  2. Article
  3. Article
  4. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Domenico AlesiDepartment of Biomedical and Neuromotor Sciences (DIBINEM) University of Bologna Bologna Italy.ORCID 0000-0002-8841-056X
Raffaele ZinnoDepartment for Life Quality Studies (QUVI) University of Bologna Rimini Italy.ORCID 0000-0001-6797-6049
Maria Scoppolini MassiniDepartment for Life Quality Studies (QUVI) University of Bologna Rimini Italy.ORCID 0009-0007-9644-6048
Giuseppe BaroneDepartment for Life Quality Studies (QUVI) University of Bologna Rimini Italy.ORCID 0000-0003-2167-4269
Davide Valente2nd Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli Bologna Italy.
Erika PinelliDepartment for Life Quality Studies (QUVI) University of Bologna Rimini Italy.ORCID 0000-0001-7451-3739
Stefano ZaffagniniDepartment of Biomedical and Neuromotor Sciences (DIBINEM) University of Bologna Bologna Italy.ORCID 0000-0002-2941-1407
Agostino Igor MirullaDepartment of Engineering University of Palermo Palermo Italy.ORCID 0000-0002-7330-6444
Laura BragonzoniDepartment for Life Quality Studies (QUVI) University of Bologna Rimini Italy.ORCID 0000-0002-4773-2300

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Purpose: This study aims to evaluate postoperative periprosthetic bone mineral density (BMD) at various time points following joint replacement with different implant designs and fixation techniques. Methods: Database search was conducted on MEDLINE, Scopus, Cochrane Central Register of Controlled Trials, Web of Science, and CINAHL for studies analyzing bone remodelling after joint replacement (March 2002-January 2024). Inclusion criteria: English-language articles; total joint replacement; at least two BMD evaluations; observational studies, cross-sectional, prospective, retrospective, randomised controlled trials, and clinical trials. Exclusion criteria: no BMD measurement within one month after surgery; BMD data only expressed as percentage changes or graphs without numerical values; no Gruen zone evaluation for hip replacement; no periprosthetic bone evaluation for knee replacement; pharmacological treatment or comorbidities affecting BMD; revision joint replacements; irrelevant articles; no full text or no original data. Results: Sixty-eight articles matched the selection criteria. Fifty-five focused on the hip joint, 12 on the knee, and one on the shoulder. After total hip arthroplasty, the greatest bone resorption occurred in the proximal femur, peaking at 6 months. Cemented implants and tapered stems showed greater bone resorption than cementless implants and anatomical stems. BMD around the acetabular component decreased during the first 6 months but increased in regions subjected to higher loads. In total knee arthroplasty, bone loss occurred in the anterior distal femur and medial tibial plateau, with cemented and posterior-stabilised implants showing greater bone loss than cementless and cruciate-retaining designs. Conclusions: The periprosthetic BMD decreases progressively after joint replacement. The fixation technique and implant design influence the extent and pattern of this decline. These factors must be considered during the surgical planning, as they can have long-term implications for bone health and implant longevity. Further research is needed to optimise implant design and surgical techniques to mitigate BMD loss and improve patient outcomes. Level of Evidence: Level IV.

Indexed as

bone mineral densityfixation techniqueimplant designregions of interesttotal hip replacementtotal knee replacement

Identifiers

PMID40401156
PMCPMC12092379

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.