Abstract
BackgroundMany factors affect implant stability and periprosthetic bone mineral density (BMD) following total joint arthroplasty. We asked whether perioperative alendronate, risedronate, calcitonin and indomethacine administration altered (1) femoral stem shear strength and periprosthetic bone mineral density BMD in ovariectomized rats and (2) whether there were differences in the effect of these drugs. MethodsThirty overiectomized rats were divided into five groups and implanted with intramedullary mini-cortical screws in the femur. Four groups were treated with alendronate, risedronate, salmon calcitonin and indomethacin for 4 weeks preoperatively and 8 weeks postoperatively. ResultsAlthough alendronate and risedronate increased the periprosthetic BMD more than calcitonin, they did not alter implant fixation compared to calcitonin. Indomethacin significantly decreased the BMD around the stem and implant stability compared to all other groups. ConclusionsThis study showed that perioperative treatment with bisphosphonates and calcitonin improved the BMD around the stems and implant stability. Although bisphosphonates increased the BMD more than calcitonin, there was no difference in implant stability. Indomethacin markedly decreased the periprosthetic BMD and implant stability. The main clinical significance of our study was the finding about the need to strictly avoid long-term use of high-dose nonsteroidal antiinflammatory drugs for patients who have major joint arthritis and a previous history of arthroplasty.
Highlights
Recent improvements in prosthesis design have encouraged surgeons to prefer cementless total hip arthroplasty (THA), even for elderly and osteoporotic patients [1]
The aim of this study was to analyze and compare the effects of perioperative treatment with alendronate, risedronate, salmon calcitonin and indomethacin on periprosthetic bone mineral density (BMD) and fixation of the femoral stem in an ovariectomized rat model of osteoporosis; a group without any medical treatment was set as the control group
A well-known analgesic drug with established anti-osteoblastic activity was added to the study design for both observations of its effects on the shear strength and BMD around the implant
Summary
Recent improvements in prosthesis design have encouraged surgeons to prefer cementless total hip arthroplasty (THA), even for elderly and osteoporotic patients [1]. Recent studies have shown that alendronate and risedronate significantly inhibit the decrease of periprosthetic bone mineral density (BMD) and bone resorption in the proximal femur after cementless THA [4,5,6]. Calcitonin has effectively enhanced the volume of the bone mass surrounding the prosthesis and significantly increased the osseointegration rate after THA [7, 8]. Many factors affect implant stability and periprosthetic bone mineral density (BMD) following total joint arthroplasty. We asked whether perioperative alendronate, risedronate, calcitonin and indomethacine administration altered (1) femoral stem shear strength and periprosthetic bone mineral density BMD in ovariectomized rats and (2) whether there were differences in the effect of these drugs. Indomethacin significantly decreased the BMD around the stem and implant stability compared to all other groups. The main clinical significance of our study was the finding about the need to strictly avoid long-term use of high-dose nonsteroidal antiinflammatory drugs for patients who have major joint arthritis and a previous history of arthroplasty
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