The Effect of a Single Infusion of Zoledronic Acid on Early Implant Migration in Total Hip Arthroplasty

Friedl, Gerald; Radl, Roman; Stihsen, Christoph; Rehak, Peter; Aigner, Reingard; Windhager, Reinhard

doi:10.2106/jbjs.g.01193

Cited by 87 publications

(87 citation statements)

References 29 publications

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“…Data from new investigations emphasise that the acetabular component may be primarily exposed to biological factors while the fixation of the femoral component may be substantially affected by non-biological factors [15]. The influence of these non-biological factors such as body weight, BMI and height upon the migration behaviour of implants is still unresolved in the literature.…”

Section: Introductionmentioning

confidence: 99%

Subsidence of a cementless femoral component influenced by body weight and body mass index

Stihsen

Radl

Keshmiri

et al. 2011

International Orthopaedics (SICOT)

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Purpose This trial was designed to evaluate the impact of physical characteristics such as body mass index, body weight and height on distal stem migration of a cementless femoral component, as the influence of obesity on the outcome of THA is still debated in literature and conflicting results have been found. Methods In this retrospective cohort study, migration patterns for 102 implants were analysed using the EinzelBild-Roentgen-Analyse (EBRA-FCA, femoral component analysis). In all cases the Vision 2000 stem was implanted and combined with the Duraloc acetabular component (DePuy, Warsaw, Indiana). Results The mean follow-up was 93 months. EBRA-FCA evaluations revealed a mean subsidence of 1.38 mm after two years, 2.06 mm after five and 2.24 mm after seven years. Five stems loosened aseptically. Correlation between increased migration over the whole period and aseptic loosening was highly significant (p<0.001). Surgical technique had a significant influence on migration and stem stability (p= 0.002) but physical patient characteristics such as body weight over 75 kg and height over 165 cm also significantly influenced stem subsidence towards progressive migration (p=0.001, p<0.001). However, a high BMI did not trigger progressive stem migration (p=0.87). Being of the male gender raised the odds for increased migration (p=0.03). Conclusion Physical characteristics such as body weight and height showed significant influence on migration patterns of this cementless femoral component. The operating surgeon should be aware that body weight above 75 kg and height over 165 cm may trigger increased stem migration and the surgeon should aim to fit these prostheses as tightly as possible. However this study demonstrates that a high BMI does not trigger progressive stem migration. Further investigations are needed to confirm our findings.

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Section: Introductionmentioning

confidence: 99%

Subsidence of a cementless femoral component influenced by body weight and body mass index

Stihsen

Radl

Keshmiri

et al. 2011

International Orthopaedics (SICOT)

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“…Clinical studies of large patient cohorts have shown that chronic systemic bisphosphonate therapy can offer benefits to patients undergoing total joint arthroplasty, including reduction of periprosthetic bone loss [2,3], reduction of implant migration [7], and reduction in revision rate [20]. However, these benefits need to be balanced against the risk of adverse events related to chronic bisphosphonate therapy [17], including atypical femur fracture.…”

Section: Discussionmentioning

confidence: 99%

“…As such, they have potential for use with orthopaedic devices designed for total joint replacement. Several clinical studies of large patient cohorts have shown that systemic delivery of bisphosphonates can reduce revision rates for total joint replacement implant loosening [2,3,7,20], but systemic treatment exposes the entire skeleton to the drug, thereby subjecting patients to the associated risks of side effects or adverse events such as nausea, vomiting, epigastric pain, and dypsepsia [17]. This potentially can be avoided by locally releasing the bisphosphonate directly from the implant to the surrounding bone as seen in our previous radioactive studies showing insignificant levels of the drug outside the direct periimplant region exposed to the bisphosphonate [5].…”

Section: Introductionmentioning

confidence: 99%

Implant-delivered Alendronate Causes a Dose-dependent Response on Net Bone Formation Around Porous Titanium Implants in Canines

Pura

Bobyn

Tänzer

2016

Clinical Orthopaedics &Amp; Related Research

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Background Bony fixation of cementless orthopaedic implants is not always achieved, particularly in challenging scenarios such as revision surgery, trauma, and tumor reconstruction. An adjunct therapy for improving porous implant fixation could improve the reliability and durability of these reconstructive procedures. Questions/purposes In this study, we asked whether there is a positive and dose-dependent effect of the local release of the bisphosphonate alendronate from (1) alendronate/ hydroxyapatite (HA) porous-coated titanium implants compared with bare metal porous controls; and (2) alendronate/HA on porous-coated titanium implants compared with HA-coated porous controls with respect to extent of bone ingrowth, bone apposition, and periimplant bone formation in a canine model? Methods Three-dimensional printed porous-coated cylindrical implants coated with three different doses (0.02, 0.06, and 0.18 mg/cm 2 ) of alendronate were inserted bilaterally in the intramedullary canal of the proximal femora of 15 adult mongrel dogs (age range, 3-9 years; mean, 5 years) weighing between 36 kg and 60 kg (mean, 43 kg). In each dog, an implant coated with HA and one of three different doses of alendronate was inserted on one side while the contralateral femur had a bare metal porous control implant and an identical control implant with a coating of HA. The dose effect of locally released alendronate on the extent of bone ingrowth, bone apposition, and periimplant bone was assessed by backscattered electron microscopy of three pairs of crosssections taken from each implant at 12 weeks after surgery. A linear mixed model was used to perform the statistical analyses to account for the correlation in the data resulting from the multiple measures performed on each dog. Results Compared with paired bare metal controls, periimplant bone increased by 92% (p = 0.007), and 114% (p\ 0.001) in the femora with the alendronate implants with a dose of 0.06 mg/cm 2 , or 0.18 mg/cm 2 , respectively. At a dose of 0.02 mg/cm 2 , there was no difference (46% change; p = 0.184, with the numbers available). The comparison of the alendronate-dosed implants with their HA-coated controls showed that the intermediate dose of 0.06 mg/cm 2 alendronate had the greatest effect on net bone formation. Bone apposition was enhanced with the 0.06-mg/cm 2 alendronate femoral implants (82%; p = 0.008), although there was no change in bone ingrowth Two of the authors certify that they (JDB, MT), or a member of their immediate families, has or may receive payments or benefits, during the study period, an amount of USD 10,000 to USD 100,000 from Pipeline Biotechnology (Cedar Knolls, NJ, USA). (37% change; p = 0.902, with the numbers available). When compared with the HA-coated control implants, the greatest effect of the alendronate-dosed implants was the increased amount of periimplant bone at the intermediate dose of 0.06-mg/cm 2 (108%, p = 0.009). There was no effect of the low (0.02-mg/cm 2 ) and high (0.18-mg/cm 2 ) alendronate-dosed implants (...

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“…Without data showing important effects on clinical outcome, a potential beneficial effect of bisphosphonates on periprosthetic bone after TJA was viewed with reservation [45]. From 2006 to the present, multiple studies established efficacy of oral alendronate on bone mineral density around the knee and the hip [1,15,18,32,47]. These studies generally related to loss of bone resulting from mechanics and not osteolysis.…”

Section: Search Strategy and Criteriamentioning

confidence: 99%

Are Biologic Treatments a Potential Approach to Wear- and Corrosion-related Problems?

Smith

Schwarz

2014

Clin Orthop Relat Res

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Where Are We Now? Biological treatments, defined as any nonsurgical intervention whose primary mechanism of action is reducing the host response to wear and/or corrosion products, have long been postulated as solutions for osteolysis and aseptic loosening of total joint arthroplasties. Despite extensive research on drugs that target the inflammatory, osteoclastic, and osteogenic responses to wear debris, no biological treatment has emerged as an approved therapy. We review the extensive preclinical research and modest clinical research to date, which has led to the central conclusion that the osteoclast is the primary target. We also allude to the significant changes in health care, unabated safety concerns about chronic immunosuppressive/antiinflammatory therapies, industry's complete lack of interest in developing an intervention for this condition, and the practical issues that have narrowly focused the possibilities for a biologic treatment for wear debris-induced osteolysis. Where Do We Need to Go? Based on the conclusions from research, and the economic, regulatory, and practical issues that limit the future directions toward the development of a biologic treatment, there are a few rational approaches that warrant investigation. These largely focus on FDA-approved osteoporosis therapies that target the osteoclast (bisphosphonates and anti-RANK ligand) and recombinant parathyroid hormone (teriparatide) prophylactic treatment to increase osseous integration of the prosthesis to overcome high-risk susceptibility to aseptic loosening. The other roadblock that must be overcome if there is to be an approved biologic therapy to prevent the progression of periprosthetic osteolysis and aseptic loosening is the development of radiological measures that can quantify a significant drug effect in a randomized, placebocontrolled clinical trial. We review the progress of volumetric quantification of osteolysis in animal studies and clinical pilots. How Do We Get There? Accepting the aforementioned rigid boundaries, we describe the emergence of repurposing FDA-approved drugs for new indications and public (National Institutes of Health, FDA, Centers for Disease Control and Prevention) and private (universities and drug and device manufactures) partnerships as the future roadmap for clinical translation. In the case of biologic treatments for wear debris-induced osteolysis, this will

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The Effect of a Single Infusion of Zoledronic Acid on Early Implant Migration in Total Hip Arthroplasty

Abstract: A single infusion of zoledronic acid shows promise in improving initial fixation of a cementless implant, which may improve the clinical outcome of total hip arthroplasty in patients with osteonecrosis of the femoral head.

Cited by 87 publications

References 29 publications

Subsidence of a cementless femoral component influenced by body weight and body mass index

Subsidence of a cementless femoral component influenced by body weight and body mass index

Implant-delivered Alendronate Causes a Dose-dependent Response on Net Bone Formation Around Porous Titanium Implants in Canines

Are Biologic Treatments a Potential Approach to Wear- and Corrosion-related Problems?

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