Total hip arthroplasty in tubercular arthritis of the hip - Surgical challenges and choice of implants.

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Abstract

Conflict of interest statement: None. 12. Calcif Tissue Int. 2022 Jul;111(1):35-46. doi: 10.1007/s00223-022-00956-2. Epub 2022 Feb 13. Klinefelter Bone Microarchitecture Evolution with Testosterone Replacement Therapy. Piot A(#)(1)(2), Plotton I(#)(3)(4)(5), Boutroy S(2), Bacchetta J(2)(6), Ailloud S(1), Lejeune H(4)(5), Chapurlat RD(1)(2), Szulc P(2), Confavreux CB(7)(8)(9). Author information: (1)Département de Rhumatologie, Hospices Civils de Lyon, Lyon, France. (2)INSERM UMR 1033, Université de Lyon, Lyon, France. (3)Hormonologie et Endocrinologie Moleculaire et Maladies Rares, Hospices Civils de Lyon, Lyon, France. (4)Départment de Médecine de la Reproduction, Hospices Civils de Lyon, Lyon, France. (5)INSERM UMR 1208, Université de Lyon, Lyon, France. (6)Service de Néphrologie Rhumatologie et Dermatologie Pédiatriques, Hospices Civils de Lyon, Lyon, France. (7)Département de Rhumatologie, Hospices Civils de Lyon, Lyon, France. cyrille.confavreux@chu-lyon.fr. (8)INSERM UMR 1033, Université de Lyon, Lyon, France. cyrille.confavreux@chu-lyon.fr. (9)Service de Rhumatologie Sud, Centre Hospitalier Lyon Sud, 165, Chemin du Grand Revoyet, 69310, Pierre Bénite, France. cyrille.confavreux@chu-lyon.fr. (#)Contributed equally Klinefelter Syndrome (KS) patients, defined by a 47 XXY karyotype, have increased risk of fragility fractures. We have assessed bone microarchitecture by high resolution peripheral quantitative CT (HR-pQCT) at the radius and tibia in young KS patients, naïve from testosterone replacement therapy (TRT). Areal bone mineral density (BMD) and body composition were assessed by dual X-ray absorptiometry (DXA). Total testosterone (tT) was measured at baseline. Bone measurements have been repeated after 30 months of TRT. We enrolled 24 KS patients and 72 age-matched controls. KS patients were (mean ± SD) 23.7 ± 7.8 year-old. KS patients had significantly lower relative appendicular lean mass index (RALM) and lower aBMD at spine and hip than controls. Ten patients (42%) had low tT level (≤ 10.4 nmol/L). At baseline, we observed at radius a marked cortical (Ct) impairment reflected by lower Ct.area, Ct.perimeter, and Ct.vBMD than controls. At tibia, in addition to cortical fragility, we also found significant alterations of trabecular (Tb) compartment with lower trabecular bone volume (BV/TV) and Tb.vBMD as compared to controls. After 30 months of TRT, 18 (75%) KS patients were reassessed. Spine aBMD and RALM significantly increased. At radius, both cortical (Ct.Pm, Ct.Ar, Ct.vBMD, Ct.Th) and trabecular (Tb.vBMD) parameters significantly improved. At tibia, the improvement was found only in the cortical compartment. Young TRT naïve KS patients have inadequate bone microarchitecture at both the radius and tibia, which can improve on TRT. © 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature. DOI: 10.1007/s00223-022-00956-2