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

  • KNEE
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

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.

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Abbreviations

BP:

Bisphosphonate

TJA:

Total joint arthroplasty

NHIS:

National Health Insurance Service

TKA:

Total knee arthroplasty

THA:

Total hip arthroplasty

HR:

Hazard ratio

ICD:

International classification of diseases

RCT:

Randomized controlled trial

References

  1. Abu-Amer Y, Darwech I, Clohisy JC (2007) Aseptic loosening of total joint replacements: mechanisms underlying osteolysis and potential therapies. Arthritis Res Ther 9(Suppl 1):S6

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Aro E, Moritz N, Mattila K, Aro HT (2018) A long-lasting bisphosphonate partially protects periprosthetic bone, but does not enhance initial stability of uncemented femoral stems: a randomized placebo-controlled trial of women undergoing total hip arthroplasty. J Biomech 75:35–45

    Article  PubMed  Google Scholar 

  3. Carano A, Teitelbaum SL, Konsek JD, Schlesinger PH, Blair HC (1990) Bisphosphonates directly inhibit the bone resorption activity of isolated avian osteoclasts in vitro. J Clin Invest 85:456–461

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Drake MT, Clarke BL, Khosla S (2008) Bisphosphonates: mechanism of action and role in clinical practice. Mayo Clin Proc 83:1032–1045

    Article  CAS  PubMed  Google Scholar 

  5. Havelin LI, Engesaeter LB, Espehaug B, Furnes O, Lie SA, Vollset SE (2000) The Norwegian Arthroplasty Register: 11 years and 73,000 arthroplasties. Acta Orthop Scand 71:337–353

    Article  CAS  PubMed  Google Scholar 

  6. Jasper LL, Jones CA, Mollins J, Pohar SL, Beaupre LA (2016) Risk factors for revision of total knee arthroplasty: a scoping review. BMC Musculoskelet Disord 17:182

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Khatod M, Inacio MC, Dell RM, Bini SA, Paxton EW, Namba RS (2015) Association of bisphosphonate use and risk of revision after THA: outcomes from a US total joint replacement registry. Clin Orthop Relat Res 473:3412–3420

    Article  PubMed  PubMed Central  Google Scholar 

  8. Kurtz S, Ong K, Lau E, Mowat F, Halpern M (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 89:780–785

    PubMed  Google Scholar 

  9. Lim CT, Goodman SB, Huddleston JI 3rd, Harris AHS, Bhowmick S, Maloney WJ et al (2017) Smoking is associated with earlier time to revision of total knee arthroplasty. Knee 24:1182–1186

    Article  PubMed  Google Scholar 

  10. Lin T, Yan SG, Cai XZ, Ying ZM (2012) Bisphosphonates for periprosthetic bone loss after joint arthroplasty: a meta-analysis of 14 randomized controlled trials. Osteoporos Int 23:1823–1834

    Article  CAS  PubMed  Google Scholar 

  11. Namba RS, Inacio MC, Cheetham TC, Dell RM, Paxton EW, Khatod MX (2016) Lower total knee arthroplasty revision risk associated with bisphosphonate use, even in patients with normal bone density. J Arthroplasty 31:537–541

    Article  PubMed  Google Scholar 

  12. Noordin S, Masri B (2012) Periprosthetic osteolysis: genetics, mechanisms and potential therapeutic interventions. Can J Surg 55:408–417

    Article  PubMed  PubMed Central  Google Scholar 

  13. Patel A, Pavlou G, Mujica-Mota RE, Toms AD (2015) The epidemiology of revision total knee and hip arthroplasty in England and Wales: a comparative analysis with projections for the United States. A study using the National Joint Registry dataset. Bone Joint J 97-B:1076–1081

    Article  CAS  PubMed  Google Scholar 

  14. Prieto-Alhambra D, Javaid MK, Judge A, Murray D, Carr A, Cooper C et al (2011) Association between bisphosphonate use and implant survival after primary total arthroplasty of the knee or hip: population based retrospective cohort study. BMJ 343:d7222

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Prieto-Alhambra D, Lalmohamed A, Abrahamsen B, Arden NK, de Boer A, Vestergaard P et al (2014) Oral bisphosphonate use and total knee/hip implant survival: validation of results in an external population-based cohort. Arthritis Rheumatol 66:3233–3240

    Article  CAS  PubMed  Google Scholar 

  16. Ren L, Wang W (2018) Effect of risedronate on femoral periprosthetic bone loss following total hip replacement: A systematic review and meta-analysis. Medicine (Baltimore) 97:e0379

    Article  CAS  Google Scholar 

  17. Singh JA, Schleck C, Harmsen WS, Jacob AK, Warner DO, Lewallen DG (2015) Current tobacco use is associated with higher rates of implant revision and deep infection after total hip or knee arthroplasty: a prospective cohort study. BMC Med 13:283

    Article  PubMed  PubMed Central  Google Scholar 

  18. Skoldenberg OG, Salemyr MO, Boden HS, Ahl TE, Adolphson PY (2011) The effect of weekly risedronate on periprosthetic bone resorption following total hip arthroplasty: a randomized, double-blind, placebo-controlled trial. J Bone Joint Surg Am 93:1857–1864

    Article  PubMed  Google Scholar 

  19. Stiehl JB, Hamelynck KJ, Voorhorst PE (2006) International multi-centre survivorship analysis of mobile bearing total knee arthroplasty. Int Orthop 30:190–199

    Article  PubMed  PubMed Central  Google Scholar 

  20. Teng S, Yi C, Krettek C, Jagodzinski M (2015) Bisphosphonate use and risk of implant revision after total hip/knee arthroplasty: a meta-analysis of observational studies. PLoS One 10:e0139927

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Thillemann TM, Pedersen AB, Mehnert F, Johnsen SP, Soballe K (2010) Postoperative use of bisphosphonates and risk of revision after primary total hip arthroplasty: a nationwide population-based study. Bone 46:946–951

    Article  CAS  PubMed  Google Scholar 

  22. Vasso M, Beaufils P, Cerciello S, Schiavone Panni A (2014) Bone loss following knee arthroplasty: potential treatment options. Arch Orthop Trauma Surg 134:543–553

    Article  PubMed  Google Scholar 

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Funding

This study was funded by a grant from the Seoul National University Hospital Research Fund (04-2017-0710).

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Author notes

  1. Du Hyun Ro and Heejin Jin contributed equally to this work.

  2. Sungho Won and Hyuk-soo Han contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea

    Du Hyun Ro, Jae-Young Park, Myung Chul Lee & Hyuk-Soo Han

  2. Department of Public Health Sciences, Seoul National University, Seoul, South Korea

    Heejin Jin & Sungho Won

Authors
  1. Du Hyun Ro
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  2. Heejin Jin
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  6. Hyuk-Soo Han
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Contributions

DHR: Design, data acquisition, data interpretation, and drafting manuscript. HJ: Data acquisition and analysis and drafting manuscript. JYP: Data acquisition, analysis and interpretation. MCL: Data acquisition and data interpretation. SW: Data acquisition and analysis, data interpretation, drafting manuscript. HSH: Design, data acquisition, data interpretation, manuscript revision.

Corresponding author

Correspondence to Hyuk-Soo Han.

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Conflict of interest

The authors certify that they have no commercial associations that might pose a conflict of interest in connection with this article.

Ethical approval

The study protocol was approved by the Institutional Review Board (Protocol No. E-1708-001-872).

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Ro, D.H., Jin, H., Park, JY. et al. The use of bisphosphonates after joint arthroplasty is associated with lower implant revision rate. Knee Surg Sports Traumatol Arthrosc 27, 2082–2089 (2019). https://doi.org/10.1007/s00167-018-5333-4

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  • DOI: https://doi.org/10.1007/s00167-018-5333-4

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