Periprosthetic bone loss is identified after inserting a hip prosthesis and is many times a result of stress shielding or altered loading of the proximal femur. Depending on the severity, the bone loss may threaten the prosthesis survival. The current study investigated the effect of cyclic etidronate therapy on periprosthetic and contralateral bone mineral density (BMD) in an one-year, prospective, randomized, double-blind study on 46 patients after cemented hip arthroplasty. Etidronate was administered orally in a regimen repeated every 14 weeks and periprosthetic BMD was measured with dual energy X-ray absorptiometry (DXA) in the total periprosthetic area and in the seven Gruen Zones at 1 week (baseline), 6 weeks, 3 months, 6 months, and 12 months postoperatively. In the etidronate group there were significant temporal BMD decreases measured in Gruen Zones 2, 3, 6, and 7 as well as in the entire proximal femur; the greatest decrease was 11.1% and was measured in Zone 2 at 12 months. Also in the etidronate group, there was a significant 3.4% increase in BMD of the spine at 12 months. In the placebo group there were significant temporal BMD decreases measured in Gruen Zones 1, 2, 3, 4, 6, and 7 as well as in the entire proximal; the greatest decrease was 16.4% and was measured in Zone 7 at 12 months. There were no significant differences between the mean BMD measurements of the etidronate and placebo groups with the exception of the mean percent change in the spine at 6 months and 12 months, and in Gruen Zone 3 at 6 months; in all three cases the etidronate group had significantly greater mean values. These findings suggest that cyclic etidronate therapy has no significant effect in surpressing the periprosthetic bone loss following cemented hip arthroplasty.

Aims: Subtrochanteric fractures in the elderly are clearly related to osteoporosis. With the new instrumentation early weight bearing in the immediate postoperative treatment offers bigger probability of the one year patientñs survival rate. Methods: We use 2 already well-established nails for diaphyseal and trochanteric fractures coupled together. The new nail enables more stability in osteoporotic diaphysis and lowers the risk of second fracture at the tip of the standard intramedulary hip screw. Results: 54 patients were operated on subtrochanteric fractures with long intramedulary hip screw in the years 1999 Ð 2000. Female to male ratio was 2.6: 1, all were older than 60 years, on average 79.1. All were operated on the second day after admission, average hospital stay was 13.9 days (impact of preoperative morbidity), no intrahospital mortality was noticed in this group. At release 61% of them walked on crutches, 31% were conþned to wheelchair. No deep infections nor delayed union were found. Interlocking screws were removed in 8 patients. The survival rate of those patients who were able to walk independently at time of discharge was signiþcantly higher (p< 0.05) and the inßuence of the longer implant is clearly established. Conclusions: We found out that in elderly people with strong osteoporosis the diaphysis should be buttressed with a long nail like in case of pathologic fractures at proximal and middle third of the femur, with indirect closed reduction. Without exposing the fracture site the osteosynthesis is performed in more biological way. Stability of the long nail positioned in the whole diaphyseal canal enables early weight bearing.