Effect of bisphosphonates on periprosthetic bone loss after total knee arthroplasty: a meta-analysis of randomized controlled trials

Abstract

BackgroundAseptic loosening and osteolysis are the most common indications after TKA for revision surgery. This meta-analysis which included high-quality randomized controlled trials (RCTs) aimed to analyze the effect of bisphosphonates (BPs) on maintaining periprosthetic bone mineral density (BMD) after total knee arthroplasty.MethodsPubMed, AMED, EMBASE, the Cochrane library, ISI Web of Science, and China National Knowledge Infrastructure were systematically searched, five RCTs were included and the total number of participants was 188. The weighted mean differences with 95% confidence interval were calculated to evaluate the efficacy of BPs on total BMD of knee and the BMD of different periprosthetic regions. A descriptive review was performed for BP-related adverse effects.ResultsThe BPs group presented significantly higher total BMD in proximal part of the tibia than the control group at 3 and 6 months (P < 0.05), but no significant difference at 12 months (P = 0.09). The BPs group presented significantly higher BMD in the distal aspect of the femur than that in the control group at 3, 6, 12 months. The BPs group presented significantly higher periprosthetic BMD than that in the control group at 3, 6 and 12 months in tibial medial and lateral metaphyseal region, and femoral anterior, central and posterior metaphyseal region (p < 0.05), but no significant difference for tibial diaphyseal region at 3, 6, and 12 months. None of the included studies described severe or fatal adverse effects related to BPs.ConclusionBPs have a short-term effect on reducing periprosthetic bone loss after total knee arthroplasty. Compared with diaphyseal region, BPs are more effective on the preservation of BMD in medial lateral metaphyseal regions of proximal tibia and in anterior, central, and posterior metaphyseal region of distal femur.

Single stage bilateral flexible intramedullary fixation of periprosthetic distal femur fractures

“…A recent meta-analysis showed a decreased risk of TKA revision (relative risk 0.45) in patients taking long-term bisphosphonates compared to patients not taking them; however, this article cautioned that more high-quality studies are needed [17]. The protective effect of bisphosphonates is thought to be due in particular to short-term improved bone mineral density in the periprosthetic metaphyseal bone, the area often most vulnerable to early failure [18]. In our patient’s case, she sustained a high energy trauma and was already being appropriately treated with bisphosphonates for pre-existing osteoporosis.…”

Prevalence and Risk Factors of Osteoporosis in Chinese Postmenopausal Women Awaiting Total Knee Arthroplasty

“…However, preoperative anti-OP treatment has been shown to lower the risk of revision and preserve periprosthetic BMD after TKA. 10,47,48 Therefore, we propose that postmenopausal women aged ≥60 years awaiting TKA who have a BMI<25 and varus knee deformity are recommended for OP screening preoperatively.…”

Three-Dimensional Quantification of Bone Mineral Density in the Distal Femur and Proximal Tibia Based on Computed Tomography: In Vitro Evaluation of an Extended Standardization Method

“…Quantifying the alterations in bone mineral density (BMD) is of interest in a number of conditions affecting the knee, including fractures [ 1 , 2 , 3 ], arthroplasty [ 4 , 5 , 6 ], meniscal damage and repair [ 7 , 8 , 9 ], osteoporosis [ 10 , 11 ], and osteoarthritis [ 12 , 13 , 14 ]. So far, in-vivo analysis of BMD has primarily relied on dual x-ray absorptiometry (DXA).…”

“…One such method was recently proposed for the proximal tibia [ 18 ]. However, as global changes in BMD have been observed in both the tibia and the femur in various pathologies [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 12 , 13 , 14 ], there is an interest to extend this method to the distal femur as well.…”