Abstract
BackgroundBone loss leading to aseptic loosening of the prosthesis and periprosthetic fracture is a mode of failure in cementless total hip arthroplasty (THA). The aim of this meta-analysis was to evaluate the effect of bisphosphonates in preventing femoral periprosthetic bone resorption following primary cementless THA zone by zone.MethodClinical randomized controlled trials concerning bisphosphonates application after primary cementless THA published up to October 2014 were retrieved from PubMed, Cochrane library, and Embase databases. The methodological quality of the included studies was assessed by the Physiotherapy Evidence Database (PEDro) scale. Data analysis was performed using StataSE12.0.ResultsTen randomized controlled trials involving a total of 502 patients were assessed; the bisphosphonates group included 256 patients and the control group included 246 patients. The meta-analysis showed that the bone mineral density (BMD) of most femoral periprosthetic zones in bisphosphonates group was significantly higher than that in the control group at 3 months postoperatively except zone 5 with no significant difference. At 6 and 12 months, the BMD of bisphosphonates group was much higher than that in control group except zone 5, which showed no statistical difference. The BMD of bisphosphonates group was persistently higher than control group in zone 6 and 7 at 5 years postoperatively, while the other zones had no significant difference. Both serum bone alkaline phosphatase and urinary type I collagen N-telopeptide were significantly suppressed by bisphosphonates at 3, 6, and 12 months.ConclusionBisphosphonates seem to decrease early femoral periprosthetic bone resorption after primary cementless THA. Drug efficacy was found to be long-standing in the main load-bearing zones.
Highlights
Bone loss leading to aseptic loosening of the prosthesis and periprosthetic fracture is a mode of failure in cementless total hip arthroplasty (THA)
The meta-analysis showed that the bone mineral density (BMD) of most femoral periprosthetic zones in bisphosphonates group was significantly higher than that in the control group at 3 months postoperatively except zone 5 with no significant difference
Inclusion criteria and exclusion criteria Inclusion criteria were as follows: (1) the target population consisted of patients undergoing primary cementless THA; (2) in the interventional group, the administration of the bisphosphonate group was oral, intramuscular, or intravenous, while the control group had been treated with calcium, alfacalcidol, or no medication; (3) the outcomes were analyzed with respect to BMD, serum bone alkaline phosphatase (BAP), and urinary Urinary type I collagen Ntelopeptide breakdown products (NTX); and (4) the methodological criterion was prospective randomized controlled trials (RCTs)
Summary
Bone loss leading to aseptic loosening of the prosthesis and periprosthetic fracture is a mode of failure in cementless total hip arthroplasty (THA). The aim of this meta-analysis was to evaluate the effect of bisphosphonates in preventing femoral periprosthetic bone resorption following primary cementless THA zone by zone. Some studies indicated that more than 75 % of the revision arthroplasties were performed for aseptic loosening of the prosthesis and periprosthetic fracture, which were all found to be the sequel to severe periprosthetic bone loss [3]. Several randomized controlled trials (RCTs) were performed to investigate the effect of bisphosphonates on femoral periprosthetic bone resorption following primary THA, most of which confirmed its efficacy, while some doubted it [5,6,7]. Two systematic reviews [8, 9] suggested that bisphosphonates have a beneficial effect on preserving periprosthetic bone in a short term after joint arthroplasty, while they had some limitations: (1) They ignored the fundamental difference between cement and cementless arthroplasty and did
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