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Online ISSN 1827-1707
Schiavon D. 1, Biber Z. 2, Fancellu G. 1, Martinelli B. 1,2
1 Scuola di Specialità di Medicina Fisica e Riabilitativa Facoltà di Medicina e Chirurgia Università degli Studi di Trieste, Trieste
2 Scuola di Specialità di Ortopedia e Traumatologia Facoltà di Medicina e Chirurgia Università degli Studi di Trieste, Trieste
Aim. Aim of this study is to evaluate the action of disodium clodronate in the periprosthetic bone after cemented hemiartroprosthesis of the hip after about 2 years of follow-up against cementeless.
Methods. The study has been carried out on a 40 patient group that had already had a dual energy X-ray absorptiometry (DEXA) examination on a fractured femur in the 12-18 months before the trauma and had not undergone osteotrophic therapy by the Ambulatory for Osteoporosis of the Orthopaedic Clinic in the University of Trieste. After surgery all the patients have been examined with DEXA after 6 months and after 2 years. Twenty patients have been treated with disodium clodronate and 20 without therapy.
Results. In the group who underwent osteotrophic therapy after an initial periprosthetic loss 6-8 months after the treatment, compared to the group not treated, we have observed an initial retrieval of the densitrometic levels until 2.5-3%, after 2 years.
Conclusions. The results obtained in this study even if satisfying and in accordance with the scientific literature, are still far away from the gold standards. The problems related to the surgical technique, with the damage of the bone nutritional system during the preparation of the femoral medullary canal and the generated heat by the cement esothermic reaction must still be solved. In case of cemented hemyartroprosthesis of the hip, the patients treated with disodium clodronate show a periprosthetic bone loss like that of patient treated with cementeless stem. These results suggest to treat these patients in any case as the disodium clodronate generally improves the calcium homeostasis, with a prevention of the generalized bone loss with a little retrieval also in the osteoporosis of the elder and performs an analgesic effect like acetylsalicylate.