[Show abstract][Hide abstract] ABSTRACT: Dual X-ray absorptionmetry (DXA) provides a highly reproducible method for quantitative analysis and monitoring periprosthetic bone mineral density (BMD) after total knee arthroplasty (TKA). Single photon emission computed tomography (SPECT) with bone avid radiopharmaceuticals reflects bone metabolic activity and circulation. We combined information from DXA and SPECT to assess the evaluation of the dynamic balance between BMD and bone turnover. Sixteen patients underwent serial DXA (Lunar Expert XL) and 99mTc-methylene diphosphonate SPECT measurements until 2 years after TKA. A rapid bone loss, up to 25.5%, was detected in femur during the first six postoperative months. However, tibial periprosthetic BMD remained close to baseline. There was a significant correlation between 12-month SPECT uptake and preceding BMD change in medial tibia (r = 0.5, P = 0.044). At 12 months, SPECT uptakes in the operated knee were notably higher compared with those of the control knee. SPECT uptakes showed statistically significant decreases from 12 months to 24 months, while SPECT uptake in the control knee remained stable. In tibia, the results are more complex; referring that increased bone remodelling is continuing below the tibial tray. Furthermore, femoral diaphyseal uptake remained elevated, while corresponding tibial uptake had levelled off at 2 years. Increased SPECT uptake during the first 2 years after uncomplicated TKA results most likely from normal postoperative bone remodelling. Levelling of SPECT uptake may indicate a new balance between bone loss and regain.