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Tang Y, Jin Z, Lu Y, Chen L, Lv S, Xu T, Tong P, Chen G. Comparing the Efficacy of Antiosteoporotic Drugs in Preventing Periprosthetic Bone Loss Following Total Hip Arthroplasty: A Systematic Review and Bayesian Network Meta-Analysis. Orthop Surg 2024. [PMID: 39056482 DOI: 10.1111/os.14165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 06/15/2024] [Accepted: 06/24/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Periprosthetic bone loss is a well-known phenomenon following total hip arthroplasty (THA). However, the choice of drugs for prevention remains controversial. Therefore, the aim of this study was to determine the best drug to treat periprosthetic bone loss by comparing changes in bone mineral density (BMD) at different times after THA. METHODS A comprehensive search of five databases and two clinical trial registration platforms was undertaken from their inception through to August 31, 2023 to identify eligible randomized controlled trials. A Bayesian network meta-analysis (NMA) was carried out for calculating the standardized mean difference (SMD) and the surface under cumulative ranking curve (SUCRA) of the BMD in calcar (Gruen zone 7) at 6 months, 12 months, and 24 months and over. RESULTS Twenty-nine trials involving 1427 patients and 10 different interventions were included. The results demonstrated that at 6 months, denosumab had the highest ranking (SUCRA = 0.90), followed by alendronate (SUCRA = 0.76), and zoledronate (SUCRA = 0.73). At 12 months, clodronate ranked highest (SUCRA = 0.96), followed by denosumab (SUCRA = 0.84) and teriparatide (SUCRA = 0.82). For interventions with a duration of 24 months and over, denosumab had the highest SUCRA value (SUCRA = 0.96), followed by raloxifene (SUCRA = 0.90) and zoledronate (SUCRA = 0.75). CONCLUSION Investigating the existing body of evidence revealed that denosumab demonstrates potential as an intervention of superior efficacy at the three specifically examined time points. However, it remains crucial to conduct further research to confirm these findings and determine the most effective treatment strategy.
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Affiliation(s)
- Yi Tang
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Zhejiang, China
| | - Zhaokai Jin
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Zhejiang, China
| | - Yichen Lu
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Zhejiang, China
| | - Lei Chen
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Zhejiang, China
| | - Shuaijie Lv
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Zhejiang, China
| | - Taotao Xu
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Zhejiang, China
| | - Peijian Tong
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Zhejiang, China
| | - Guoqian Chen
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Zhejiang, China
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Cho CH, Pijls BG, Abrahams JM, Roerink A, Katembwe R, Baker A, Solomon LB, Callary SA. Migration patterns of acetabular cups: a systematic review and meta-analysis of RSA studies. Acta Orthop 2023; 94:626-634. [PMID: 38157007 PMCID: PMC10757199 DOI: 10.2340/17453674.2023.24580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 09/21/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND PURPOSE We conducted a systematic review and meta-analysis of RSA studies to investigate the early and long-term migration patterns of acetabular cups and the influence of implant factors on cup migration over time. METHODS We performed a systematic search of PubMed, Embase, and Scopus databases to identify all RSA studies of cup migration following primary total hip replacement (THR). Proximal migration at 3 and 6 months, 1, 2, 5, and 10 years were considered for analysis. Implant factors investigated included fixation type, head size, bearing surface, uncemented coating design, and the decade of RSA introduction. RESULTS 47 studies reported the proximal migration of 83 cohorts (2,328 cups). Besides 1 threaded cup design, no implant factor investigated was found to significantly influence proximal migration. The mean pooled 2-year proximal migration of cemented cups (0.14 mm, 95% confidence interval [CI] 0.08-0.20) was not significantly different from uncemented cups (0.12 mm, CI 0.04-0.19). The mean pooled proximal migration at 6 months was 0.11 mm (CI 0.06-0.16) and there was no significant increase between 6 months and 2 years (0.015 mm, CI 0.000-0.030). 27 of 75 cohorts (36%) reported mean proximal migration greater than 0.2 mm at 2 years, which has previously been identified as a predictor of implants at risk of long-term loosening. CONCLUSION Our meta-analysis demonstrated that the majority of cup migration occurs within the first 6 months. With one exception, no implant factors influenced the 2-year proximal migration of acetabular cups. 36% of studies with 2-year migration were considered at risk of long-term loosening. Further investigation and comparison against long-term survivorship data would validate 6-month and/or 1-year proximal migration measurements as an earlier predictor of long-term loosening than the current 2-year threshold.
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Affiliation(s)
- Chan Hee Cho
- Centre for Orthopaedic and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia.
| | - Bart G Pijls
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, Netherlands
| | - John M Abrahams
- Centre for Orthopaedic and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Anne Roerink
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, Netherlands
| | - Raissa Katembwe
- Centre for Orthopaedic and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Andrew Baker
- Centre for Orthopaedic and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Lucian B Solomon
- Centre for Orthopaedic and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Stuart A Callary
- Centre for Orthopaedic and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA, Australia
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Li X, Han J, Shi X, Bi Z, Liu J. Zoledronic acid and denosumab for periprosthetic bone mineral density loss after joint arthroplasty: a systematic review and meta-analysis of randomized controlled trials. Arch Osteoporos 2023; 18:37. [PMID: 36840811 DOI: 10.1007/s11657-023-01227-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/10/2023] [Indexed: 02/26/2023]
Abstract
OBJECTIVE Periprosthetic bone mineral density (BMD) loss after total hip arthroplasty (THA) may threaten the survival of implants. Zoledronic acid (ZA) and denosumab were effective in reducing bone loss in conditions associated with accelerated bone turnover by inhibiting osteoclast activity. This meta-analysis aimed to assess the efficiency and safety of ZA and denosumab for periprosthetic BMD loss after THA. METHODS A systematic search of randomized controlled trials (RCTs) associated with ZA or denosumab and THA was performed in MEDLINE, PubMed, Embase, the Cochrane Central Register of Controlled Trials, and the Web of Science from 1980 to 2022. Meta-analysis was performed by the Cochrane Review Manager 5 (RevMan) version 5.41. Cochrane risk of bias tool and GRADEpro were applied for methodological quality and overall evidence quality, respectively. RESULTS Nine RCTs involving a total of 480 patients were finally included and analyzed. The pooled data that demonstrated significantly less periprosthetic BMD loss in Gruen zone 7 occurred in the intervention group patients than in the control group patients at 3 months (MD = 4.30, 95% CI: 1.78-6.82, P = 0.0008), 6 months (MD = 7.71, 95% CI: 5.41-10.02, P < 0.00001), and 12 months (MD = 8.19, 95% CI: 5.97-10.42, P < 0.00001) after THA. No serious adverse events (AEs) were observed. CONCLUSION In the current analysis with evidence on the efficacy and safety of ZA and denosumab, the authors recommend the use of ZA or denosumab treatment for periprosthetic bone mineral density loss. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number: CRD42022369273.
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Affiliation(s)
- Xiao Li
- Department of Orthopedics, First Hospital of Jilin University, Changchun, Jilin, China
| | - Jingru Han
- Department of Oncology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaotong Shi
- Department of Orthopedics, First Hospital of Jilin University, Changchun, Jilin, China
| | - Zhiguo Bi
- Department of Orthopedics, First Hospital of Jilin University, Changchun, Jilin, China
| | - Jianguo Liu
- Department of Orthopedics, First Hospital of Jilin University, Changchun, Jilin, China.
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