The Effect of Weekly Risedronate on Periprosthetic Bone Resorption Following Total Hip Arthroplasty

Sköldenberg, Olof; Salemyr, Mats; Bodén, Henrik; Ahl, Torbjörn; Adolphson, Per

doi:10.2106/jbjs.j.01646

Cited by 72 publications

(62 citation statements)

References 195 publications

(331 reference statements)

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“…A number of previous studies have indicated that the approaches from the front of the joint have a distinct advantage of reducing the rate of postoperative dislocation [14,43,45]. Our findings confirm these observations.…”

Section: Discussionsupporting

confidence: 91%

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Anterior and Anterolateral Approaches for THA Are Associated With Lower Dislocation Risk Without Higher Revision Risk

Sheth

Cafri

Inacio

et al. 2015

Clinical Orthopaedics &Amp; Related Research

190

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Background Lack of consensus continues regarding the benefit of anteriorly based surgical approaches for primary total hip arthroplasty (THA). The purpose of this study was to evaluate the risk of aseptic revision, septic revision, and dislocations for various approaches used in primary THAs from a community-based healthcare organization. Questions/purposes (1) What is the incidence of aseptic revision, septic revision, and dislocation for primary THA in a large community-based healthcare organization? (2) Does the risk of aseptic revision, septic revision, and dislocation vary by THA surgical approach? Methods The Kaiser Permanente Total Joint Replacement Registry was used to identify primary THAs performed between April 1, 2001 and December 31, 2011. Endpoints were septic revisions, aseptic revisions, and dislocations. The exposure of interest was surgical approach (posterior, anterolateral, direct lateral, direct anterior). Patient, implant, surgeon, and hospital factors were evaluated as possible confounders. Survival analysis was performed with marginal multivariate Cox models. Hazard ratios (HRs) and 95% confidence intervals (CIs) are reported. A total of 42,438 primary THAs were available for analysis of revision outcomes and 22,237 for dislocation. Median followup was 3 years (interquartile range, 1-5 years). The registry's voluntary participation is 95%. The most commonly used approach was posterior (75%, N = 31,747) followed by anterolateral (10%, N = 4226), direct anterior (4%, N = 1851), and direct lateral (2%, N = 667). Results During the study period 785 hips (2%) were revised for aseptic reasons, 213 (0.5%) for septic reasons, and 276 (1%) experienced a dislocation. The revision rate per 100 years of observation was 0.54 for aseptic revisions, 0.15 for septic revisions, and 0.58 for dislocations. There were no differences in adjusted risk of revision (either septic or aseptic) across the different THA approaches. However, the anterolateral approach (adjusted HR, 0.29; 95% CI, 0.13-0.63, p = 0.002) and direct anterior approach (adjusted HR, 0.44; 95% CI, 0.22-0.87, p = 0.017) had a lower risk of dislocation relative to the posterior approach. There were no differences in any of the outcomes when comparing the direct anterior approach with the anterolateral approach. Conclusions Anterior and anterolateral surgical approaches had the advantage of a lower risk of dislocation without increasing the risk of early revision. Level of Evidence Level III, therapeutic study.

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Section: Discussionsupporting

confidence: 91%

“…The main advantage of anteriorly based approaches has been reduction in the incidence of hip dislocation [14,43,45,51]. However, some studies have expressed concern regarding implant malposition that could compromise long-term survival of the implant [3,33].…”

Section: Introductionmentioning

confidence: 99%

Anterior and Anterolateral Approaches for THA Are Associated With Lower Dislocation Risk Without Higher Revision Risk

Sheth

Cafri

Inacio

et al. 2015

Clinical Orthopaedics &Amp; Related Research

190

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“…At least up to 2 years after surgery, the ultra-short stem preserves femoral bone, which is advantageous should a later stem revision be necessary. Bone remodeling in the control group was in accordance with an earlier study with this stem by our research group (Sköldenberg et al 2011). In a study of the current ultra-short stem, Kim et al (2011a) found bone remodeling in accordance with our results.…”

Section: Discussionsupporting

confidence: 89%

Lower periprosthetic bone loss and good fixation of an ultra-short stem compared to a conventional stem in uncemented total hip arthroplasty

Salemyr¹,

Muren²,

Ahl³

et al. 2015

Acta Orthopaedica

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Background and purpose — We hypothesized that an ultra-short stem would load the proximal femur in a more physiological way and could therefore reduce the adaptive periprosthetic bone loss known as stress shielding.Patients and methods — 51 patients with primary hip osteoarthritis were randomized to total hip arthroplasty (THA) with either an ultra-short stem or a conventional tapered stem. The primary endpoint was change in periprosthetic bone mineral density (BMD), measured with dual-energy x-ray absorptiometry (DXA), in Gruen zones 1 and 7, two years after surgery. Secondary endpoints were change in periprosthetic BMD in the entire periprosthetic region, i.e. Gruen zones 1 through 7, stem migration measured with radiostereometric analysis (RSA), and function measured with self-administered functional scores.Results — The periprosthetic decrease in BMD was statistically significantly lower with the ultra-short stem. In Gruen zone 1, the mean difference was 18% (95% CI: −27% to −10%). In zone 7, the difference was 5% (CI: −12% to −3%) and for Gruen zones 1–7 the difference was also 5% (CI: −9% to −2%). During the first 6 weeks postoperatively, the ultra-short stems migrated 0.77 mm more on average than the conventional stems. 3 months after surgery, no further migration was seen. The functional scores improved during the study and were similar in the 2 groups.Interpretation — Up to 2 years after total hip arthroplasty, compared to the conventional tapered stem the ultra-short uncemented anatomical stem induced lower periprosthetic bone loss and had equally excellent stem fixation and clinical outcome.

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“…Inadequate quantity or quality of the supporting bone can contribute to THA failure, including aseptic loosening and periprosthetic fracture [27,28]. Multiple studies have evaluated the effect of bisphosphonate use on bone mineral density (BMD) surrounding THA devices [1,2,5,12,15,16,29,32,37,38]. All the studies focused on the short-term effect of a single antiosteoporotic agent on the BMD surrounding the implant.…”

Section: Introductionmentioning

confidence: 99%

Association of Bisphosphonate Use and Risk of Revision After THA: Outcomes From a US Total Joint Replacement Registry

Khatod

Inacio

Dell

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Total hip arthroplasty (THA) is often performed in patients who are older and may take bisphosphonates to treat a variety of conditions, most commonly osteoporosis. However, the clinical effects of bisphosphonate use on patients who have undergone THA are not well described. Questions/purposes (1) Is bisphosphonate use in patients with osteoarthritis undergoing primary THA associated with a change in the risk of all-cause revision, aseptic revision, or periprosthetic fracture compared with patients not treated with bisphosphonates? (2) Does the risk of bisphosphonate use and revision and periprosthetic fracture vary by patient bone mineral density and age? Methods A retrospective cohort study of 12,878 THA recipients for the diagnosis of osteoarthritis was conducted; 17.8% of patients were bisphosphonate users. Data sources for this study included a joint replacement registry (93% voluntary participation) and electronic health records and an osteoporosis screening database with complete capture of cases as part of the Kaiser Permanente integrated healthcare system. The endpoints for this study were revision surgery for any cause, aseptic revision, and periprosthetic fracture. The exposure of interest was bisphosphonate use; patients were considered users if prescriptions were continuously refilled for a period equal to or longer than 6 months. Bone quality (based on dual-energy x-ray absorptiometery ordered based on the National Osteoporosis Foundation's clinical guidelines taken within 5 years of the THA) and patient age (\ 65 versus C 65 years) were evaluated as effect modifiers. Patient, surgeon, and hospital factors were evaluated as confounders. Cox proportional hazards models were used. Hazard ratios (HRs) and 95% confidence intervals (CIs) were determined. Results Age-and sex-adjusted risks of all-cause (HR, 0.50; 95% CI, 0.33-0.74; p \ 0.001) and aseptic revision Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Clinical Orthopaedics and Related Research 1 neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDAapproval status, of any drug or device prior to clinical use. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. HR, 0.53; 95% CI,; p = 0.004) was lower in bisphosphonate users than in nonusers. The adjusted risk of periprosthetic fractures in patients o...

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The Effect of Weekly Risedronate on Periprosthetic Bone Resorption Following Total Hip Arthroplasty

Cited by 72 publications

References 195 publications

Anterior and Anterolateral Approaches for THA Are Associated With Lower Dislocation Risk Without Higher Revision Risk

Anterior and Anterolateral Approaches for THA Are Associated With Lower Dislocation Risk Without Higher Revision Risk

Lower periprosthetic bone loss and good fixation of an ultra-short stem compared to a conventional stem in uncemented total hip arthroplasty

Association of Bisphosphonate Use and Risk of Revision After THA: Outcomes From a US Total Joint Replacement Registry

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