Osseointegration in arthroplasty: can simvastatin promote bone response to implants?

Abstract

Cementless fixation depends on bone ingrowth for long-term success. Simvastatin as a lipid lowering agent has been demonstrated to have osteoanabolic effects. This study was designed to measure the possible effect of simvastatin on implant osseointegration. Bilateral femoral implantation of titanium cylinders was performed in 20 rabbits. Blood lipid levels were measured pre-and postoperatively. Scanning electron microscopy (SEM) was used to measure the percentage of the surface of each implant in contact with bone and mechanical pull-out testing was performed. The blood lipid levels were significantly reduced in the simvastatin group. Histomorphometric examination revealed increased bone ingrowth and mechanical examination showed increased interface strength in the simvastatin group. Mechanical and histological data showed superior stability and osseous adaptation at the bone/ implant interface for the simvastatin group. We conclude that simvastatin has potential as a means of enhancing bone ingrowth, which is a key factor in the longevity of cementless implants.Résumé La fixation d'une prothèse sans ciment dépend de la réhabitation osseuse. La Simvastatine est un agent lipidique qui a un effet ostéo anabolique. Cette étude a pour but de montrer les effets de la Simvastatine sur l'ostéo intégration osseuse. Matériel et méthode : une implantation de cylindres de titane a été réalisée sur les deux fémurs de vingt lapins. Le taux de lipide a été mesuré en pré et post opératoire. L'examen en microscopique électronique a mesuré le pourcentage de la surface de réhabitation et des essais d'arrachage ont également été réalisés. Résultats : le niveau des lipides sanguins est réduit de façon significative dans le groupe de Simvastatine. L'histomorphométrie osseuse montre la croissance, l'orientation de la réhabitation et les tests mécaniques, l'augmentation de l'interface avec augmentation des forces nécessaires pour l'arrachage. En conclusion, les données mécaniques et histologiques montrent une stabilité supérieure dans le groupe Simvastatine. Nous pouvons conclure que la Simvastatine a un potentiel d'augmentation de la réhabitation osseuse facteur clé du succès à long terme des implants sans ciment.

The influence of statins on osseointegration: a systematic review of animal model studies

“…Ten studies presented some data on mechanical tests, including removal torque analysis, push‐out test, pull‐out test and push‐in test, to assess the strength of the newly formed bone around implants. Eight studies showed significant results for the groups with statins compared to the control groups after at least 2 weeks. One publication showed significant results after 56 days.…”

Serum bone formation marker correlation with improved osseointegration in osteoporotic rats treated with simvastatin

“…Statins have therefore been proposed as potential agents in the treatment of osteoporosis. Previous studies also suggest that simvastatin can promote osteogenesis around titanium implants (Ayukawa et al 2004, Ayukawa et al 2010, Basarir et al 2009).…”

“…Previous studies also suggest that simvastatin can promote osteogenesis around titanium implants (Ayukawa et al. , Ayukawa et al , Basarir et al ).…”

Statins, Bone Biology and Revision Arthroplasty: Review of Clinical and Experimental Evidence

“…In multiple animal studies, systemic administration of simvastatin after implant insertion has been demonstrated to promote osseointegration, increase bone density around implants and crucially, to increase the mechanical strength/stability of the bone-implant interface [25][26][27][28] In addition to systemic statin administration it has been proposed that local application of statins (particularly fluvastatin) to implants may promote similar osteogenic effects, increasing mechanical strength and improving peri-implant bony calcification [30][31][32] .…”