The use of bisphosphonates after joint arthroplasty is associated with lower implant revision rate

Abstract

Purpose This study hypothesized that the use of bisphosphonates (BPs) after total joint arthroplasty (TJA) is associated with a lower implant revision rate. This study aimed (1) to investigate the association between BP use and the revision rate of TJA and (2) to determine the relationship between the medication period and the revision rate of TJA. Methods National Health Insurance Service data on surgeries, medications, diagnoses, and screenings of 50 million Koreans were reviewed. People who underwent TJA in the period from 2002 to 2012 were identified and followed until 2016. During that period, 331,660 patients underwent total knee arthroplasty (TKA), and 56,043 patients underwent total hip arthroplasty (THA). Among them, 8447 knee patients (2.5%) and 2851 hip patients (5.0%) required revision surgery due to aseptic loosening. Demographic data, the duration of BP medication, and comorbidities were identified. The rate of revision surgery according to BP medication was investigated. The extended Cox proportional hazard model was used to evaluate the effect of the medication period. Results The rate of TKA revision was 1.4% for BP users and 2.9% for BP non‐users (p < 0.001). The THA revision rate was 2.8% and 5.3% for BP users and non‐users, respectively (p < 0.001). The hazard ratio (HR) of revision was significantly lower in patients who took BP medication for more than one year (TKA HR = 0.472, 95% CI [0.350–0.637]; THA HR = 0.490, 95% CI [0.247–0.972]) compared to that in short‐term users (less than 1 year). Conclusions The use of BPs after TJA was associated with a lower revision rate. The use of BPs for more than one year further reduced the risk of revision. Bisphosphonate use can be highly recommended to reduce the revision rate of TJA. Level of evidence Retrospective cohort study, Level III.

Multitasking by the OC Lineage during Bone Infection: Bone Resorption, Immune Modulation, and Microbial Niche

“…However, the presence of bacterial biofilms, which are resistant to antibiotics, has driven treatment paradigms that require mechanical debridement, replacement of hardware, and antibiotics, but not the specific targeting of other host factors such as OCs. Antiresorptive drugs have been successfully used in sterile forms of osteomyelitis, including chronic non-bacterial osteomyelitis and diffuse sclerosing osteomyelitis [ 103 , 104 , 105 ], as well as to reduce aseptic loosening of prosthetic joints [ 106 ]. These OC-targeting therapeutics have been implicated in cases of osteonecrosis of the jaw (ONJ), which is considered to be an entity separate from iOM of the jaw [ 107 ].…”

The action of anti-resorptive drugs on the survival of total knee and hip arthroplasty

“…In both TKA (331,660 patients of whom 88% were female) and THA (56,043 patients of whom 45% were female ), the revision rate was significantly lower in BP users (both p<0.001) . The hazard ratio of revision surgery was lower in the patients who received the medication for more than 1 year (p<0.001) 20 .…”

Bisphosphonates in Total Joint Arthroplasty: A Review of Their Use and Complications

“…[ 26 ] Meta-analysis 34,116 TKA All bisphosphonates Aseptic revision rate Ro et al. [ 27 ] Meta-analysis 56,043 THA 331,660 TKA THA/TKA All bisphosphonates All-cause revision rate Prieto-Alhambra et al. [ 28 ] Case-control meta-analysis 10,524 THA/TKA All bisphosphonates All-cause revision rate Yang [ 29 ] Meta-analysis of RCTs 198 THA Risedronate Bone mineral density Teng [ 30 ] Meta-analysis 31,293 THA/TKA All bisphosphonates All-cause revision rate Zhou et al.…”

“…Another meta-analysis also examined the rate of revisions in patients who underwent TKA (331,660 patients) and THA (56,043 patients) [ 27 ]. These patients were followed up between 4 and 14 years.…”