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Niesen AE, Hull ML. State of the Art in Radiostereometric Analysis for Tibial Baseplate Migration and Future Research Directions. J Biomech Eng 2023; 145:120801. [PMID: 37792485 DOI: 10.1115/1.4063626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 09/25/2023] [Indexed: 10/06/2023]
Abstract
Radiostereometric analysis (RSA) measures movement (migration) of a baseplate relative to the underlying tibia after total knee arthroplasty (TKA) and has been used extensively to evaluate safety of new implant designs and/or surgical techniques regarding baseplate loosening. Because RSA is a complex methodology which involves various choices that researchers make, including whether to use marker-based or model-based methods, which migration metric to report, how to relate short-term migrations to long-term risk, and how these choices impact error, the objectives of this review were to: (1) lay out a comprehensive structure illustrating the multiple components/considerations for RSA and their interrelations, (2) review components of the structure using the latest RSA literature, and (3) use the preceding review as a context for identifying future areas of study. The components to be reviewed were structured using the following topics: type of RSA, migration metrics, sources of error, studies/reports of error, stability limits, and studies of error in stability limits. Based on the current RSA literature and knowledge gaps which exist, the following future research directions were identified: (1) revising the ISO standard to require reporting of clinical measurement error (bias) and recommending use of a local baseplate coordinate system, (2) identifying the migration metric and associated threshold most predictive of baseplate loosening for individual patients, (3) creating a method for data sharing to improve individual patient diagnostics, and (4) determining an appropriate stability limit for model-based RSA for group stability and individual patient diagnostics.
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Affiliation(s)
- Abigail E Niesen
- Department of Biomedical Engineering, University of California, Davis, One Shields Avenue, Davis, CA 95616
| | - Maury L Hull
- Department of Biomedical Engineering, University of California, Davis, One Shields Avenue, Davis, CA 95616; Department of Mechanical Engineering, University of California, Davis, One Shields Avenue, Davis, CA 95616; Department of Orthopaedic Surgery, University of California Davis Medical Center, 4860 Y Street, Suite 3800, Sacramento, CA 95817
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2
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Molfetta L, Casabella A, Rosini S, Saviola G, Palermo A. Role of the osteochondral unit in the pathogenesis of osteoarthritis: focus on the potential use of clodronate. Curr Rheumatol Rev 2021; 18:2-11. [PMID: 34615451 DOI: 10.2174/1573397117666211006094117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/10/2021] [Accepted: 07/20/2021] [Indexed: 11/22/2022]
Abstract
Osteoarthritis (OA) is a chronic disease characterized by inflammation and progressive deterioration of the joint. The etiology of OA includes genetic, phlogistic, dismetabolic and mechanical factors. Historically, cartilage was considered the target of the disease and therapy was aimed at protecting and lubricating the articular cartilage. The osteochondral unit is composed of articular cartilage, calcified cartilage, and subchondral and trabecular bone, which work synergistically to support the functional loading of the joint. Numerous studies today show that OA involves the osteochondral unit, with the participation therefore of the bone in the starting and progression of the disease, which is associated with chondropathy. Cytokines involved in the process leading to cartilage damage are also mediators of subchondral bone edema. Therefore, OA therapy must be based on the use of painkillers and bisphosphonates for both the control of osteometabolic damage and its analgesic activity. Monitoring of the disease of the osteochondral unit must be extensive, since bone marrow edema can be considered as a marker of the evolution of OA. In the present review we discuss some of the pathogenetic mechanisms associated with osteoarthritis, with particular focus on the osteochondral unit and the use of clodronate.
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Affiliation(s)
- Luigi Molfetta
- DISC Department of Integrated Surgical and Diagnostic science, School of Medical and Pharmaceutical Sciences, University of Genoa, Genoa. Italy
| | - Andrea Casabella
- DiMI Department of Internal Medicine Osteoporosis, Bone and Joint Disease Research Center, CROPO, Geno. Italy
| | | | - Gianantonio Saviola
- Istituti Clinici Scientifici Maugeri IRCCS, Rheumatology and Rehabilitation Unit of the Institute of Castel Goffredo, Mantua. Italy
| | - Andrea Palermo
- IRCCS Auxologico Italian Institute - 3 Unit of Orthopaedic Surgery - Capitanio Hospital, Milan. Italy
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Kiuttu J, Lehenkari P, Leskelä HV, Yrjämä O, Ohtonen P, Valkealahti M. Intra-operative Clodronate Rinsing Improves the Integration of the Femoral Stem in a Prospective, Double-blinded, Randomized, Placebo-controlled Clinical RSA-study. Open Orthop J 2021. [DOI: 10.2174/1874325002115010001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
Background:
Periprosthetic bone loss after Total Hip Arthroplasty (THA), detected as an early migration of the prosthesis may predict later loosening of the implant.
Objective:
We hypothesized that intra-operative bisphosphonate rinsing would reduce bone resorption after THA. It might therefore be possible to achieve better early fixation of the implant.
Methods:
Nineteen patients suffering from arthrosis were recruited in a prospective, double-blinded, randomized, placebo-controlled clinical pilot trial. Patients were operated with an uncemented Bimetric stem using tantalum markers. The femoral proximal intramedullary canal was rinsed with 1mM clodronate in nine patients and with saline in 10 patients. These patients were followed for two years using radiostereometric analysis (RSA), dual energy x-ray absorptiometry (DXA) and the Harris Hip Score (HHS).
Results:
We did not found any significant differences between the study groups with regards to the primary output measures (maximum total point motion, MTPM). However, there was evidence that clodronate could affect periprosthetic bone quality; a beneficial effect in BMD in Gruen zone 3 during the two-year follow-up was observed, BMD decreased less in the clodronate group (p = 0.02). The maximal x-translation of the stem at 3-24 months was significantly two-fold, being higher in the placebo group (p = 0.02). The baseline BMD and the maximal total point motion (MTPM) at 3-24 months showed a positive correlation in the clodronate group and a negative correlation in the placebo group.
Conclusion:
In conclusion, further studies with larger patient groups and longer follow-up periods are needed to estimate the clinical importance of these findings and further to prove if an intraoperative clodronate rinsing prior to application of femoral stem during THA can prevent periprosthetic bone loss.
Clinical Trial Registration No.: NCT03803839
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Abtahi J, Klintström B, Klintström E. Ibandronate Reduces the Surface Bone Resorption of Mandibular Bone Grafts: A Randomized Trial With Internal Controls. JBMR Plus 2021; 5:e10468. [PMID: 33778329 PMCID: PMC7990152 DOI: 10.1002/jbm4.10468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/13/2021] [Accepted: 01/18/2021] [Indexed: 11/19/2022] Open
Abstract
Autologous bone grafts are considered the gold standard for reconstruction of the edentulous alveolar ridges. However, this procedure is associated with unpredictable bone loss caused by physiological bone resorption. Bisphosphonates are antiresorptive drugs that act specifically on osteoclasts, thereby maintaining bone density, volume, and strength. It was hypothesized that the resorption of bone grafts treated with an ibandronate solution would be less advanced than bone grafts treated with saline. Ten patients who underwent bilateral sagittal split osteotomy were included in a randomized double‐blind trial with internal controls. Each patient received a bone graft treated with a solution of ibandronate on one side and a graft treated with saline (controls) contralaterally. Radiographs for the measurement of bone volume were obtained at 2 weeks and at 6 months after surgery. The primary endpoint was the difference in the change of bone volume between the control and the ibandronate bone grafts 6 months after surgery. All of the bone grafts healed without complications. One patient was excluded because of reoperation. In eight of the nine patients, the ibandronate bone grafts showed an increase in bone volume compared with baseline, with an average gain of 126 mm3 (40% more than baseline) with a range of +27 to +218 mm3. Only one ibandronate‐treated graft had a decrease in bone volume (8%). In the controls, an average bone volume loss of −146 mm3 (58% of baseline) with a range of −29 to −301 mm3 was seen. In the maxillofacial field, the reconstructions of atrophic alveolar ridges, especially in the esthetical zones, are challenging. These results show that bone grafts locally treated with ibandronate solution increases the remaining bone volume. This might lead to new possibilities for the maxillofacial surgeons in the preservation of bone graft volumes and for dental implant installations. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC. on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Jahan Abtahi
- Department of Oral & Maxillofacial Surgery and Department of Biomedical and Clinical Sciences Linköping University Linköping Sweden.,Center for Medical Image Science and Visualization (CMIV) Linköping University Linköping Sweden
| | - Benjamin Klintström
- Department of Biomedical Engineering and Health Systems KTH Royal Institute of Technology Stockholm Sweden
| | - Eva Klintström
- Center for Medical Image Science and Visualization (CMIV) Linköping University Linköping Sweden.,Department of Radiology and Department of Health, Medicine and Caring Sciences Linköping University Linköping Sweden
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Mahri M, Shen N, Berrizbeitia F, Rodan R, Daer A, Faigan M, Taqi D, Wu KY, Ahmadi M, Ducret M, Emami E, Tamimi F. Osseointegration Pharmacology: A Systematic Mapping Using Artificial Intelligence. Acta Biomater 2021; 119:284-302. [PMID: 33181361 DOI: 10.1016/j.actbio.2020.11.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/04/2020] [Accepted: 11/05/2020] [Indexed: 12/25/2022]
Abstract
Clinical performance of osseointegrated implants could be compromised by the medications taken by patients. The effect of a specific medication on osseointegration can be easily investigated using traditional systematic reviews. However, assessment of all known medications requires the use of evidence mapping methods. These methods allow assessment of complex questions, but they are very resource intensive when done manually. The objective of this study was to develop a machine learning algorithm to automatically map the literature assessing the effect of medications on osseointegration. Datasets of articles classified manually were used to train a machine-learning algorithm based on Support Vector Machines. The algorithm was then validated and used to screen 599,604 articles identified with an extremely sensitive search strategy. The algorithm included 281 relevant articles that described the effect of 31 different drugs on osseointegration. This approach achieved an accuracy of 95%, and compared to manual screening, it reduced the workload by 93%. The systematic mapping revealed that the treatment outcomes of osseointegrated medical devices could be influenced by drugs affecting homeostasis, inflammation, cell proliferation and bone remodeling. The effect of all known medications on the performance of osseointegrated medical devices can be assessed using evidence mappings executed with highly accurate machine learning algorithms.
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Wilkinson JM. The use of bisphosphonates to meet orthopaedic challenges. Bone 2020; 137:115443. [PMID: 32445893 DOI: 10.1016/j.bone.2020.115443] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/14/2020] [Accepted: 05/19/2020] [Indexed: 11/17/2022]
Abstract
The anti-resorptive properties of bisphosphonates have been explored to manage several conditions that traditionally have required a surgical solution. In osteonecrosis, their use is predicated on the principle that bone collapse occurs during the revascularisation phase of the disease. If the associated resorptive activity were modulated, the resultant preserved joint architecture may improve clinical outcome and reduce the need for joint replacement. Pre-clinical and small-scale clinical studies have given non-conclusive support for this principle. Adequately powered clinical trials with relevant long-term endpoints are still required to firmly clarify the clinical efficacy of this treatment. Several clinical studies have shown that bisphosphonates can reduce periprosthetic bone loss and, in some situations, enhance implant fixation in the early period after joint replacement. This may be advantageous in settings where osseointegration is problematic. However, the ultimate goals of their use in joint replacement has been to reduce the incidence of late periprosthetic inflammatory osteolysis, the main cause of prosthesis failure. Population-based observational studies have associated bisphosphonate use with a lower incidence of revision surgery, supported by pre-clinical data. However, clinical trials have, to date, failed to demonstrate any efficacy for the human disease. The timing of bisphosphonate administration for secondary prevention after acute osteoporotic fracture has been subject to extensive investigation, with pre-clinical studies showing increased callus formation but decreased remodelling and no effect on the restoration of mechanical integrity of bone. Meta-analysis of clinical trial data indicates that early administration of bisphosphonate after acute fracture does not adversely affect fracture union, pain or functional outcomes. Finally, bisphosphonates have also been explored as a treatment for complex regional pain syndrome type-I. A recent meta-analysis has shown a beneficial effect on visual analogue scale pain scores, but an increase in mild adverse events.
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Affiliation(s)
- J Mark Wilkinson
- Department of Oncology and Metabolism, University of Sheffield, United Kingdom.
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Saviola G, Ferrari P, Niccolò E, Casabella A, Ghellere F, Bonazzi S, Lul AA, Comini L, Molfetta L. Use of clodronate for painful knee prosthesis in osteoarthritis patients: a 6-month pilot study. Minerva Med 2020; 111:551-559. [PMID: 32573517 DOI: 10.23736/s0026-4806.20.06706-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Knee replacement surgery is one of the most common surgical procedures performed worldwide. Unfortunately, knee prostheses can become painful over time, necessitating appropriate analgesic treatment. Bisphosphonates such as clodronate (CLO) may play an important role in the treatment of painful knee prostheses by virtue of its analgesic and anti-inflammatory properties. METHODS In this prospective open label pilot study, eighteen consecutive patients aged 73.2±8.9 years affected by knee painful prosthesis and osteoarthritis were treated with a rehabilitation cycle in addition to i.v. or i.m. CLO. Induction dose was 2.0-2.1g, followed by a weekly dose of 200 mg (i.m.) for 6 months. Visual analogue scale (VAS) pain score and Tegner Lysholm Score (TLS) were used to assess improvement following CLO treatment. RESULTS Thirteen out of 18 patients completed the 6-month follow-up. VAS pain score decreased from 8.1±1.8 at baseline to 5.6±2.6 (P<0.05) and TLS increased from 40.4±20.3 at baseline to 62.7±24.1 at 6 months (P<0.05). Univariate regression revealed that among a range of variables, BMI was positively correlated with VAS (r=0.73, P=0.004) and lower TLS after 1 month (r= -0.62, P=0.006). CONCLUSIONS CLO in association with rehabilitation exercises can reduce pain and ameliorate the functionality of painful knee prostheses. Administration of a high dose (induction dose) of CLO every 3 months appears to be the most effective regimen compared to a weekly maintenance dose.
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Affiliation(s)
- Gianantonio Saviola
- Unit of Rheumatology and Rehabilitation, Institute of Castel Goffredo, IRCCS Maugeri Clinical Scientific Institutes, Mantua, Italy -
| | - Paolo Ferrari
- Unit of Orthopedics, San Pellegrino Hospital, Castiglione delle Stiviere, Mantua, Italy
| | - Ernesto Niccolò
- Unit of Orthopedics, San Pellegrino Hospital, Castiglione delle Stiviere, Mantua, Italy
| | - Andrea Casabella
- School of Medical and Pharmaceutical Sciences, Research Center of Osteoporosis and Osteoarticular Pathologies, University of Genoa, Genoa, Italy
| | - Francesco Ghellere
- Unit of Rheumatology and Rehabilitation, Institute of Castel Goffredo, IRCCS Maugeri Clinical Scientific Institutes, Mantua, Italy.,Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Sonia Bonazzi
- Unit of Rheumatology and Rehabilitation, Institute of Castel Goffredo, IRCCS Maugeri Clinical Scientific Institutes, Mantua, Italy
| | - Abdi-Ali Lul
- Unit of Rheumatology and Rehabilitation, Institute of Castel Goffredo, IRCCS Maugeri Clinical Scientific Institutes, Mantua, Italy
| | - Laura Comini
- Scientific Direction of the Institute of Lumezzane, IRCCS Maugeri Clinical Scientific Institutes, Brescia, Italy
| | - Luigi Molfetta
- School of Medical and Pharmaceutical Sciences, Research Center of Osteoporosis and Osteoarticular Pathologies, University of Genoa, Genoa, Italy
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Mosbahi S, Oudadesse H, Roiland C, Lefeuvre B, Slimani L, Keskes H. Risedronate Effects on the In Vivo Bioactive Glass Behavior: Nuclear Magnetic Resonance and Histopathological Studies. BIOMED RESEARCH INTERNATIONAL 2019; 2019:2175731. [PMID: 31915685 PMCID: PMC6935465 DOI: 10.1155/2019/2175731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 08/24/2019] [Indexed: 11/18/2022]
Abstract
The present study aimed to enhance the anti-osteoporotic performance of bioactive glass (46S6) through its association with bisphosphonate such as risedronate with amounts of 8, 12, and 20%. Obtained composites have been called 46S6-8RIS, 46S6-12RIS, and 46S6-20RIS, respectively. In vitro and in vivo explorations have been carried out. Bioactive glass and risedronate association has been performed by adsorption process. Structure analyses have been carried out to evaluate and to understand their chemical interactions. Solid Nuclear Magnetic Resonance (NMR) has been employed to study the structural properties of obtained biocomposite. The spectra deconvolution showed the appearance of a species (Q 4) in the biocomposites 46S6-8RIS, 46S6-12RIS, and 46S6-20RIS indicating their successful chemical association. In vitro experiments showed the enhancement of the chemical reactivity of the composites 46S6-xRIS compared to the pure bioactive glass. In fact, the silicon liberation after 30 days of immersion was 50 ppm for pure bioactive glass 46S6, and 41, 64, and 62 from 46S6-8RIS, 46S6-12RIS, and 46S6-20RIS, respectively. Based on the in vitro results, 46S6-8RIS was implanted in the femoral condyle of an ovariectomized rat and compared with implanted pure glass in the goal to highlight its anti-osteoporotic performance. After 60 days, implanted group with 46S6-8RIS showed the increase in bone mineral density (BMD with 10%) and bone volume fraction (BV/TV with 80%) and the decrease in trabecular separation (Tb/Sp with 74%) when compared to that of 46S6 group. These results are confirmed by the histopathological analyses, which showed the bone trabeculae reconnection after the 46S6-8RIS implantation. Chemical analyses showed the reduction in silicon (Si) and sodium (Na) ion concentrations, and the rise in calcium (Ca) and phosphorus (P) ion levels, which was explained by the dissolution of biocomposite matrix and the deposition of hydroxyapatite layer. Histomorphometric results highlighted the risedronate effect on the antiosteoporotic phenomenon. Obtained results showed good behavior with only 8% of introduced risedronate in the glass matrix.
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Affiliation(s)
- Siwar Mosbahi
- Univ Rennes, CNRS, ISCR-UMR 6226, F-3500Rennes, France
- Experimental Surgery of the Musculoskeletal System Laboratory, Sfax Faculty of Medicine, Sfax, Tunisia
| | | | | | | | - Lotfi Slimani
- EA2496, Faculty of Dentistry, Paris Descartes University, Montrouge, France
| | - Hassib Keskes
- Experimental Surgery of the Musculoskeletal System Laboratory, Sfax Faculty of Medicine, Sfax, Tunisia
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McArthur BA, Scully R, Patrick Ross F, Bostrom MPG, Falghren A. Mechanically Induced Periprosthetic Osteolysis: A Systematic Review. HSS J 2019; 15:286-296. [PMID: 31624485 PMCID: PMC6778158 DOI: 10.1007/s11420-018-9641-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 09/25/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Peri-prosthetic bone loss can result from chemical, biological, and mechanical factors. Mechanical stimulation via fluid pressure and flow at the bone-implant interface may be a significant cause. Evidence supporting mechanically induced osteolysis continues to grow, but there is no synthesis of published clinical and basic science data. QUESTIONS/PURPOSES We sought to review the literature on two questions: (1) What published evidence supports the concept of mechanically induced osteolysis? (2) What is the proposed mechanism of mechanically induced osteolysis, and does it differ from that of particle-induced osteolysis? METHODS A systematic review was performed of the PubMed and Web of Science databases. Additional relevant articles were recommended by the senior authors based on their expert opinion. Abstracts were reviewed and the manuscripts pertaining to the study questions were read in full. Studies showing support of mechanically induced osteolysis were quantified and findings summarized. RESULTS We identified 49 articles of experimental design supporting the hypothesis that mechanical stimulation of peri-prosthetic bone from fluid pressure and flow can induce osteolysis. While the molecular mechanisms may overlap with those implicated in particle-induced osteolysis, mechanically induced osteolysis appears to be mediated by distinct and parallel pathways. CONCLUSIONS The role of mechanical stimuli is increasingly recognized in the pathogenesis of peri-prosthetic osteolysis. Current research aims to elucidate the molecular mechanisms to better target therapeutic interventions.
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Affiliation(s)
- Benjamin A. McArthur
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas, Texas Orthopedics Sports and Rehabilitation Associates, 4215 Benner Road, Ste. 300, Kyle, TX 78640 USA
| | - Ryan Scully
- Department of Orthopedic Surgery, George Washington University, 2300 M Street, NW, Washington, DC, 20037 USA
| | - F. Patrick Ross
- Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021 USA
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Liu WB, Zhao WT, Shen P, Zhang FJ. The effects of bisphosphonates on osteoporotic patients after lumbar fusion: a meta-analysis. DRUG DESIGN DEVELOPMENT AND THERAPY 2018; 12:2233-2240. [PMID: 30046237 PMCID: PMC6054279 DOI: 10.2147/dddt.s164548] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Purpose We conducted a meta-analysis of controlled clinical trials to evaluate the efficacy of bisphosphonates in lumbar fusion. Introduction Bisphosphonates reduce bone resorption and remodeling by osteoclast activity inhibition, inactivation, and apoptosis. However, it remains controversial whether bisphosphonate therapy affects spinal fusion. Methods We searched MEDLINE, Cochrane CENTRAL, ScienceDirect, EMBASE, and Google Scholar to identify studies reporting the effects of bisphosphonates on osteoporotic patients after lumbar fusion. Secondary sources were identified from the references of the included literature. Pooled data were analyzed using RevMan 5.1. Results Seven studies met the inclusion criteria. There were significant differences in solid intervertebral fusion (RD=0.07, 95% CI: −0.00 to 0.15, P=0.05), subsequent VCFs (RD=−0.21, 95% CI: −0.30 to −0.12, P<0.00001), pedicle screw loosening (RD=−0.17, 95% CI: −0.28 to −0.05, P=0.006), and cage subsidence (RD=−0.25, 95% CI: −0.42 to −0.07, P=0.005) between two groups. No significant differences between two groups were found regarding implant fixation failure (RD=−0.06, 95% CI: −0.22 to 0.10, P=0.48). Conclusion This meta-analysis showed that bisphosphonates may increase solid intervertebral fusion and decrease subsequent VCFs, pedicle screw loosening, and cage subsidence.
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Affiliation(s)
- Wen-Bin Liu
- Department of Joint Surgery, Tianjin Hospital, Tianjin 300211, People's Republic of China,
| | - Wen-Tao Zhao
- Department of Orthopedics, The First Affiliated Hospital of Yunnan Traditional Chinese Medical University, Yunnan 650021, People's Republic of China
| | - Peng Shen
- Department of Rheumatology and Immunology, Tianjin First Center Hospital, Tianjin 300192, People's Republic of China
| | - Fu-Jiang Zhang
- Department of Joint Surgery, Tianjin Hospital, Tianjin 300211, People's Republic of China,
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Yang L. The efficiency of risedronate in reducing bone resorption after total hip arthroplasty: a meta-analysis of randomized control trials at a minimum of 6 months' follow-up. J Orthop Surg Res 2018; 13:88. [PMID: 29665839 PMCID: PMC5904972 DOI: 10.1186/s13018-018-0808-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 04/06/2018] [Indexed: 11/22/2022] Open
Abstract
Background Recently risedronate is suggested to be effective for the prevention and treatment of for osteoporosis in total hip arthroplasty. This meta-analysis aimes to evaluate the efficacy of risedronate in reducing femoral periprosthetic bone mineral density loss in patients undergoing primary total hip arthroplasty. Methods A systematic search was performed in Medline (1966-31 October 2017), PubMed (1966-31 October 2017), Embase (1980-31 October 2017), ScienceDirect (1985-31 October 2017) and the Cochrane Library. Only randomized controlled trial (RCT) were included. Fixed/random effect model was used according to the heterogeneity tested by I2 statistic. Meta-analysis was performed using Stata 11.0 software. The outcome measures included periprosthetic bone mineral density, length of stay and adverse effects. Results Four RCTs including 198 patients met the inclusion criteria. The present meta-analysis showed that there were significant differences between treatment groups in terms of periprosthetic bone mineral density in Gruen zones 1 (standard mean difference (SMD) = 0.758, 95% CI 0.469 to 1.047, P = 0.000), 2 (SMD = 0.814, 95% CI 0.523 to 1.106, P = 0.000), 3 (SMD = 0.340, 95% CI 0.059 to 0.622, P = 0.018), 6 (SMD = 2.400, 95% CI 2.029 to 2.771, P = 0.000), and 7 (SMD = 2.400, 95% CI 2.029 to 2.771, P = 0.000). Conclusion Oral risedronate could significantly reduce periprosthetic bone resorption around an uncemented femoral stem (Gruen zones 1, 2, 3, 6, and 7) up to 6 months after THA. In addition, no severe adverse events were identified. Future trials of risedronate treatment after THA should focus on clinically relevant end points such as the risks of fracture and revision arthroplasty.
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Affiliation(s)
- Liqing Yang
- Department of Orthopedics, Shengjing Hospital of China Medical University, Shenyang, 110004, China.
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12
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Cleemann R, Bechtold JE, Sorensen M, Soballe K, Baas J. Dose-Dependent Resorption of Allograft by rhBMP-2 Uncompensated by New Bone Formation-A Canine Study With Implants and Zoledronate. J Arthroplasty 2018; 33:1215-1221.e1. [PMID: 29248483 DOI: 10.1016/j.arth.2017.11.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 10/26/2017] [Accepted: 11/07/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Impacted bone allograft is used to restore lost bone in total joint arthroplasties. Bone morphogenetic proteins (BMPs) can induce new bone formation to improve allograft incorporation, but they simultaneously invoke a seemingly dose-dependent allograft resorption mediated by osteoclasts. Bisphosphonates effectively inhibit osteoclast activity. Predicting allograft resorption when augmented with bone morphogenetic protein 2 (BMP-2), we intended to investigate whether a balanced bone metabolism was achievable within a range of BMP-2 doses with systemic zoledronate treatment. METHODS Implants were coated with 1 of 3 BMP-2 doses (15 μg, 60 μg, and 240 μg) or left untreated. Implants were surrounded by a 2.5-mm gap filled with impacted morselized allograft. Each of the 12 dogs included received 1 of each implant (15 μg, 60 μg, 240 μg, and untreated), 2 in each proximal humerus. During the 4-week observation period, zoledronate intravenous (0.1 mg/kg) was administered to all animals 10 days after surgery as anticatabolic treatment. Implant osseointegration was evaluated by histomorphometry and mechanical push-out tests. RESULTS Untreated implants had the best mechanical fixation and superior retention of allograft as compared to any of the BMP-2 implants. Both mechanical implant fixation and retention of allograft decreased significantly with BMP-2 dose increments. Surprisingly, there was no difference among the treatment groups in the amount of new bone. CONCLUSION The use of BMP-2 to augment impaction-grafted implants cannot be recommended even when combined with systemic zoledronate.
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Affiliation(s)
- Rasmus Cleemann
- Orthopaedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark; Elective Surgery Center, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Joan E Bechtold
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis Medical Research Foundation, Minneapolis, Minnesota
| | - Mette Sorensen
- Department of Orthopaedic Surgery, Viborg Regional Hospital, Viborg, Denmark
| | - Kjeld Soballe
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Jorgen Baas
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
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13
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Abstract
BACKGROUND Periprosthetic osteolysis by polyethylene wear debris-triggered osteoclasts is viewed as the main pathophysiological pathway in aseptic loosening in total hip arthroplasty. The present aim was to study osteoclast occurrence in osteolytic lesions in early and late revisions of the Charnley low-friction torque arthroplasty (CLFA). METHODS Biopsies of the soft interface membrane and the adjacent bone were taken from osteolytic lesions during revision of 16 loose CLFA, early (2-6 years) or late (>10 years) after primary surgery. By light microscopy (LM), cell-dense regions with signs of osteoclast-mediated bone resorption were selected for transmission electron microscopy. Three additional patients were studied in LM for osteoclast markers (tartrate-resistant acid phosphatase and Cathepsin K). RESULTS LM disclosed a low-grade chronic inflammation and birefringent particles in most sections. Multiple conglomerates of tartrate-resistant acid phosphatase positive and Cathepsin K positive mononuclear and multinucleated cells were found deep in the fibrous interface membrane. Transmission electron microscopy showed traces of polyethylene-like particles in 67%-100% of the cells. Osteoclast-like cells exhibiting resorptive activity were few (mean, 0.7%; standard deviation, 0.2%), and multinucleated cells, possibly osteoclast precursor cells, located immediately on the bone were also scarce (mean, 2.7%; standard deviation, 5.3%). Multinucleated (odds ratio, 3.0; 95% confidence interval, 1.7-5.5) and macrophage-like cells (odds ratio, 3.6; 95% confidence interval, 2.2-5.6) were typically located deeper in the inflammatory interface membrane with a pathologic appearance with distension and abundance of phagocytic vacuoles. There were no systematic differences in cell populations between early or late revisions. CONCLUSION Despite probable ongoing osteoclastogenesis in the osteolytic lesions, there were few sites of osteoclast-mediated bone resorption. These findings attach a contributing biological explanation to the longevity of the CLFA.
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14
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Ledin H, Good L, Aspenberg P. Denosumab reduces early migration in total knee replacement. Acta Orthop 2017; 88:255-258. [PMID: 28287004 PMCID: PMC5434591 DOI: 10.1080/17453674.2017.1300746] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 01/19/2017] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Aseptic loosening is a main cause of late revision in total knee replacement (TKR). Migration of implants as measured by radiostereometric analysis (RSA) can predict future loosening. This migration is associated with bone resorption. Denosumab is a human monoclonal antibody that binds to receptors on osteoclast precursors and osteoclasts. This prevents osteoclast formation, resulting in less bone resorption in cortical and trabecular bone. We investigated whether denosumab can reduce migration of TKR, as measured with RSA. Patients and methods - In this 2-center, randomized, double-blind placebo-controlled trial, 50 patients with osteoarthritis of the knee were treated with an injection of either denosumab (60 mg) or placebo 1 day after knee replacement surgery and again after 6 months. RSA was performed postoperatively and after 6, 12, and 24 months. The primary effect variable was RSA maximal total point motion (MTPM) after 12 months. We also measured other RSA variables and the knee osteoarthritis outcome score (KOOS). Results - The primary effect variable, MTPM after 12 months, showed that migration in the denosumab group was statistically significantly less than in the controls. Denosumab MTPM 12 months was reduced by one-third (denosumab: median 0.24 mm, 10% and 90% percentiles: 0.15 and 0.41; placebo: median 0.36 mm, 10% and 90% percentiles: 0.20 and 0.62). The secondary MTPM variables (6 and 24 months) also showed a statistically significant reduction in migration. There was no significant difference in MTPM for the period 12-24 months. KOOS sub-variables were similiar between denosumab and placebo after 12 and 24 months. Interpretation - Denosumab reduces early migration in total knee replacement, as in previous trials using bisphosphonates. As migration is related to the risk of late loosening, denosumab may be beneficial for long-term results.
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Affiliation(s)
- Håkan Ledin
- Orthopedics, Department of Clinical and Experimental Medicine, Faculty of Medicine, Linköping University, Linköping;
- Department of Orthopedics, Aleris Specialist Care Motala AB, Motala;
| | - Lars Good
- Department of Orthopedics, Oskarshamn Hospital, Oskarshamn, Sweden
| | - Per Aspenberg
- Orthopedics, Department of Clinical and Experimental Medicine, Faculty of Medicine, Linköping University, Linköping;
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15
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Abstract
Background and purpose - Aseptic loosening is a main cause of late revision in total knee replacement (TKR). Teriparatide, a recombinant parathyroid hormone (PTH), stimulates osteoblasts and has been suggested to improve cancellous bone healing in humans. This might also be relevant for prosthesis fixation. We used radiostereometric analysis (RSA) to investigate whether teriparatide influences prosthesis fixation. Early migration as measured by RSA can predict future loosening. Patients and methods - In a randomized controlled trial with blind evaluation, 50 patients with osteoarthritis of the knee were allocated to a teriparatide treatment group (Forsteo, 20 μg daily for 2 months postoperatively) or to an untreated control group. RSA was performed postoperatively and at 6 months, 12 months, and 24 months. The primary effect variable was maximal total point motion (MTPM) from 12 to 24 months. Results - Median maximal total point motion from 12 to 24 months was similar in the 2 groups (teriparatide: 0.14 mm, 10% and 90% percentiles: 0.08 and 0.24; control: 0.13 mm, 10% and 90% percentiles: 0.09 and 0.21). [Authors: this is perhaps better than using "10th" and "90th", which looks ugly in print./language editor] The 95% confidence interval for the difference between group means was -0.03 to 0.04 mm, indicating that no difference occurred. Interpretation - We found no effect of teriparatide on migration in total knee replacement. Other trials using the same dosing have suggested a positive effect of teriparatide on human cancellous fracture healing. Thus, the lack of effect on migration may have been due to something other than the dose. In a similar study in this issue of Acta Orthopaedica, we found that migration could be reduced with denosumab (Ledin et al. 2017 ). The difference in response between the anabolic substance teriparatide and the antiresorptive denosumab suggests that resorption has a more important role during the postoperative course than any deficit in bone formation.
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Affiliation(s)
- Håkan Ledin
- Orthopedics, Department of Clinical and Experimental Medicine, Faculty of Medicine, Linköping University, Linköping;,Department of Orthopedics, Aleris Specialist Care Motala AB, Motala;,Correspondence:
| | - Lars Good
- Department of Orthopedics, Hospital of Oskarshamn, Oskarshamn
| | - Torsten Johansson
- Orthopedics, Department of Clinical and Experimental Medicine, Faculty of Medicine, Linköping University, Norrköping, Sweden
| | - Per Aspenberg
- Orthopedics, Department of Clinical and Experimental Medicine, Faculty of Medicine, Linköping University, Linköping
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16
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Abtahi J, Henefalk G, Aspenberg P. Randomised trial of bisphosphonate-coated dental implants: Radiographic follow-up after five years of loading. Int J Oral Maxillofac Surg 2016; 45:1564-1569. [PMID: 27688166 DOI: 10.1016/j.ijom.2016.09.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 07/09/2016] [Accepted: 09/07/2016] [Indexed: 11/27/2022]
Abstract
The results of a randomised trial with bisphosphonate-coated dental implants have been reported previously. Each patient received one coated and one uncoated implant in a double-blind split-mouth design study. After 6 months of osseointegration, resonance frequency analysis indicated better fixation of the coated implants. Reduced marginal bone resorption was also shown. However, it was not known whether the advantage of the bisphosphonate coating would persist over time. The radiographic results at 5 years after implant installation are reported herein. A blinded investigator measured marginal resorption on fresh radiographs obtained for 14 of the 16 patients (two had died) and compared these with the post-implantation images. Non-parametric statistics were used. All implants functioned well. The median marginal bone loss for control implants was found to be 0.70mm, which is less than usually reported in the literature. The bisphosphonate-coated implants showed even less resorption (median 0.20mm). The median difference within each pair of implants after 5 years of use was 0.34mm (95% confidence interval 0.00-0.75mm; P=0.04). The present data suggest that bisphosphonate-coated implants enable prolonged preservation of the marginal bone.
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Affiliation(s)
- J Abtahi
- Orthopaedics, Department of Clinical and Experimental Medicine, Faculty of Medicine, Linköping University, Linköping, Sweden; Department of Oral and Maxillofacial Surgery, Linköping University Hospital, Linköping, Sweden.
| | - G Henefalk
- Department of Oral and Maxillofacial Surgery, Linköping University Hospital, Linköping, Sweden
| | - P Aspenberg
- Orthopaedics, Department of Clinical and Experimental Medicine, Faculty of Medicine, Linköping University, Linköping, Sweden
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17
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Ejaz A, Laursen AC, Jakobsen T, Rasmussen S, Nielsen PT, Laursen MB. Absence of a Tourniquet Does Not Affect Fixation of Cemented TKA: A Randomized RSA Study of 70 Patients. J Arthroplasty 2015; 30:2128-32. [PMID: 26162514 DOI: 10.1016/j.arth.2015.05.058] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 05/25/2015] [Accepted: 05/29/2015] [Indexed: 02/01/2023] Open
Abstract
We aimed to determine whether not using a tourniquet in cemented TKA would affect migration of the tibial component measured by radiosterometric analysis (RSA). Seventy patients were randomized into a tourniquet group and a non-tourniquet group and using model-based RSA, the migration of the tibial component was analyzed. Primary and secondary outcome measures were maximum total point motion (MTPM) and translations and rotations. Follow-up period was 2 years. The tibial component was well fixated in both groups and no significant difference in migration between the two groups was detected (P=0.632). Mean MTPM (SD) was 0.47 mm (0.16) in the tourniquet group and 0.45 mm (0.21) in the non-tourniquet group. Absence of tourniquet indicates that stable fixation of the tibial component can be achieved in cemented TKA.
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Affiliation(s)
- Ashir Ejaz
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark; Orthopaedic Surgery Research Unit, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Anders C Laursen
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark; Orthopaedic Surgery Research Unit, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Thomas Jakobsen
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Sten Rasmussen
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark; Orthopaedic Surgery Research Unit, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Poul Torben Nielsen
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Mogens B Laursen
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark; Orthopaedic Surgery Research Unit, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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18
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Abstract
Clodronate is the father of bisphosphonates. For over three decades it has been subject of study in biological and clinical areas, proving to be an extremely interesting molecule from different points of view. It has been the first drug for osteoporosis that can be administered pulsatorily (once every 15 days or once a week). This, along with good tolerability, has been the first cause of its success, when there were no solid data in literature about its antifracture efficacy. There are three published studies that prove its antifracture effect: two by McCloskey published in 2004 and 2007 on BMR, and our study about fracture prevention in corticosteroids OP. In these studies a dose of 800 mg/day orally administered or 100 mg/week I.M. was used, and they are basically the same if you consider that clodronate absorption, orally administered, is on average 1.9%. However, a series of works where higher doses were used (1600 mg orally administered) with greater effectiveness on bone mass, especially in higher risk populations, lead us to consider the use of 200 mg i.m. formulation. First of all, we proved densitometric equivalence of 200 mg i.m./14 days and 100 mg i.m./week in a first study; then, in a second study, we proved a greater densitometric efficacy of 200 mg/week compared to 100 mg/week, clearer at femoral level, where the drug had not proven to prevent femoral fracture because of inadequate bone mass increase at that level. Moreover, as for ibandronate case, monthly dose was doubled compared to pivotal trial, in order to maximize the effects on femoral bone mass and therefore prevent femoral fractures. Consequently, on the basis of the risk envelope, whether it is identified according to BMD and the presence of one risk factor at least or more correctly identified through risk chart (FRAX or DeFRA), you can put forward a differential use of 100 mg i.m. and 200 mg i.m., weekly, "off-label" or every 14 days, adjusting doses in relation to fracture risk and painful symptoms gravity, as well as improving its ease of use and therefore assist compliance. Common experience and clinical and biological works have proved that clodronate has an analgesic effect that can be increased by doubling the doses. The analgesic effect is present not only with patients with fractures, but also with patients suffering from osteoarthritis or arthritis. Therefore, the drug would fit well in the therapeutic program of rheumatic patient, also because of its symptomatic effects. Clodronate at small doses (2 mg) could also have protective effects on cartilage (introduction of intra-articular formulation is expected) and at 10-100 fold higher doses it has certainly anti-inflammatory effects and more specifically antimacrophage and anticytokine effects (IL-1, IL-6, TNFalpha, PGE). These effects are amplified by putting clodronate in monolayer liposomes. This drug, therefore, has to be considered as adjuvant in arthritis therapy, whose origin can be linked to a strong osteoclastic activation caused by an increase of cytokines and the RANKL/OPG relationship. It is clear that clodronate can work on cytokine at first and on osteoclastic effector in the end. The drug has been used "off-label" for decades intravenously in complex regional pain syndrome (CRPS type 1) in relation to schemes that change according to different Authors and according to cumulative doses ranging from 3 to 5 g. The introduction on the market of the 200 mg i.m. formulation could allow to get more practical but equally effective schemes. For example, we used this scheme: 200 mg/day for 10 days and then 200 mg every other day for 20 days (cumulative dose of 4 g in a month). Said scheme can be repeated in the following months in particular cases. Results, as for efficacy and lack of relapses, show that clodronate is the leader drug for this syndrome. In recent years, relationship between costs and benefits has started to matter, especially after the creation of some algorithms, such as FRAX, that let us choose patients with a higher fracture risk in 10 years, and after pharmaceutic-economic models that let us calculate FRAX intervention threshold, on the basis of drug price and monitoring, antifracture efficacy, quality of life and how much a community can or wants to spend. In this respect, a sub-analysis of McCloskey's study on people over the age of 75, conducted on 3974 subjects, shows that clodronate is more efficient with patients with a higher fracture risk, calculated according to FRAX. Furthermore, another study by McCloskey revealed that, for a 100-pound/year drug (very similar to clodronate), 'cost effective' intervention threshold is about 7-10%. In conclusion, clodronate prevents fractures, decrease osteo-articular pain, is easy to handle, tolerable and had a great cost/benefit relationship.
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Affiliation(s)
- Bruno Frediani
- Medical and Surgical Science and Neuroscience Department, Rheumatology Section, University of Siena, O.U. of Osteo-Articular Diagnostic Procedures, Siena, Italy
| | - Ilaria Bertoldi
- Medical and Surgical Science and Neuroscience Department, Rheumatology Section, University of Siena, O.U. of Osteo-Articular Diagnostic Procedures, Siena, Italy
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19
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Skripitz R, Kurth A, Roth A. [Supportive drugs for improved implant healing]. DER ORTHOPADE 2015; 44:703-709. [PMID: 26160658 DOI: 10.1007/s00132-015-3136-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Improvement of implant healing in orthopedic and trauma surgery serves to improve the life expectancy of the implant. Good primary stability by clamping is a prerequisite for secondary stability and for the actual integration and healing of the implant. RESULTS Possible causes of implant loosening are abrasive particles, which arrive at non-integrated implants at the unsealed prosthesis-bone interface and provoke a macrophage-mediated foreign body reaction, resulting in periprosthetic osteolysis. Numerous animal studies have already described the use of bisphosphonates to inhibit osteolysis induced by abrasion and secondary instability. In patients with total knee arthroplasty, a decrease in prosthetic migration under the influence of bisphosphonates could be shown. The stimulation of bone formation around the implants and the resulting implant healing was demonstrated both in animal experiments for bone morphogenetic proteins (BMP) and in case reports for intermittent parathyroid hormone administration. CONCLUSION By using supportive drugs, it is possible to achieve an improvement in the osseointegration of implants; thus, more rapid secondary stability and load-bearing are expected.
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Affiliation(s)
- R Skripitz
- Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, Doberaner Str. 142, 18057, Rostock, Deutschland.
| | - A Kurth
- Themistocles Gluck Hospital, Ratingen, Deutschland
| | - A Roth
- Bereich Endoprothetik/Orthopädie, Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinik Leipzig AöR, Leipzig, Deutschland
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20
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Jaroma AVJ, Soininvaara TA, Kröger H. Effect of one-year post-operative alendronate treatment on periprosthetic bone after total knee arthroplasty. Bone Joint J 2015; 97-B:337-45. [DOI: 10.1302/0301-620x.97b3.33643] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Total knee arthroplasty (TKA) is known to lead to a reduction in periprosthetic bone mineral density (BMD). In theory, this may lead to migration, instability and aseptic loosening of the prosthetic components. Bisphosphonates inhibit bone resorption and may reduce this loss in BMD. We hypothesised that treatment with bisphosphonates and calcium would lead to improved BMD and clinical outcomes compared with treatment with calcium supplementation alone following TKA. A total of 26 patients, (nine male and 17 female, mean age 67 years) were prospectively randomised into two study groups: alendronate and calcium (bisphosphonate group, n = 14) or calcium only (control group, n = 12). Dual energy X-ray absorptiometry (DEXA) measurements were performed post-operatively, and at three months, six months, one, two, four, and seven years post-operatively. Mean femoral metaphyseal BMD was significantly higher in the bisphosphonate group compared with controls, up to four years following surgery in some areas of the femur (p = 0.045). BMD was observed to increase in the lateral tibial metaphysis in the bisphosphonate group until seven years (p = 0.002), and was significantly higher than that observed in the control group throughout (p = 0.024). There were no significant differences between the groups in the central femoral metaphyseal, tibial medial metaphyseal or diaphyseal regions of interest (ROI) of either the femur or tibia. Bisphosphonate treatment after TKA may be of benefit for patients with poor bone quality. However, further studies with a larger number of patients are necessary to assess whether this is clinically beneficial. Cite this article: Bone Joint J 2015;97-B:337–45.
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Affiliation(s)
- A. V. J. Jaroma
- Kuopio University Hospital, Omakotitie
61, Kuopio, 70600, Finland
| | - T. A. Soininvaara
- Central Hospital of North Carelia, Tikkamäentie
16, 80210 Joensuu, Finland
| | - H. Kröger
- University of Eastern Finland, P.O.
Box 100, 70029 KYS. Kuopio, Finland
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21
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Risedronate does not enhance fixation or BMD in revision cups: randomised study with three years follow-up. Hip Int 2014; 24:49-55. [PMID: 24186676 DOI: 10.5301/hipint.5000081] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2013] [Indexed: 02/04/2023]
Abstract
BACKGROUND Bisphosphonates may improve implant fixation by inhibition of bone resorption and stimulation of osteoblasts by up regulation of BMP-2. However, there are few clinical studies in this area. QUESTIONS/PURPOSE Does treatment with oral bisphosphonates improve implant fixation and bone remodelling around the acetabular component after revision arthroplasty with or without use of morselised allograft? PATIENTS AND METHODS Fifty-three patients received university pharmacy blinded medication for three months: 5 mg risedronate or placebo one dosage and 1 g calcium carbonate and 800IE cholecalciferol per day. Forty-one patients were operated upon with revision of the cup. The revisions were performed with an uncemented (Trilogy, Zimmer, Warsaw, USA) or a cemented (Ogee, Depuy Int, England) cup. Radiostereometric analysis was obtained within one week after the operation, at three and six months, and after one, two and three years to study cup migration. Bone mineral density was measured postoperatively, at six months, one and two years, using DEXA. The presence and extension of radiolucent lines and graft remodelling were studied on conventional radiography. RESULTS The risendronate group revealed less anterior-posterior rotation at 6 months. We found no significant differences in migration at three years, change in bone mineral density, or graft remodelling and radiolucent lines formation between groups. CONCLUSIONS We could not demonstrate any beneficial effects of oral administration of risedronate on the fixation, bone mineral density or bone remodelling of revision cups using various amount of bone graft.
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22
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Rasmusson L, Abtahi J. Bisphosphonate associated osteonecrosis of the jaw: an update on pathophysiology, risk factors, and treatment. Int J Dent 2014; 2014:471035. [PMID: 25254048 PMCID: PMC4164242 DOI: 10.1155/2014/471035] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 07/18/2014] [Indexed: 01/06/2023] Open
Abstract
Osteonecrosis of the jaw in patients treated with bisphosphonates is a relatively rare but well known complication at maxillofacial units around the world. It has been speculated that the medication, especially long-term i.v. bisphosphonate treatment, could cause sterile necrosis of the jaws. The aim of this narrative review of the literature was to elaborate on the pathological mechanisms behind the condition and also to gather an update on incidence, risk factors, and treatment of bisphosphonate associated osteonecrosis of the jaw. In total, ninety-one articles were reviewed. All were published in internationally recognized journals with referee systems. We can conclude that necrotic lesions in the jaw seem to be following upon exposure of bone, for example, after tooth extractions, while other interventions like implant placement do not increase the risk of osteonecrosis. Since exposure to the bacterial environment in the oral cavity seems essential for the development of necrotic lesions, we believe that the condition is in fact chronic osteomyelitis and should be treated accordingly.
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Affiliation(s)
- Lars Rasmusson
- Department Oral and Maxillofacial Surgery, The Sahlgrenska Academy, University of Gothenburg, P.O. Box 450, 405 30 Gothenburg, Sweden
| | - Jahan Abtahi
- Maxillofacial Unit, Linköping University Hospital, 581 85 Linköping, Sweden
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23
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Madanat R, Mäkinen TJ, Aro HT, Bragdon C, Malchau H. Adherence of hip and knee arthroplasty studies to RSA standardization guidelines. A systematic review. Acta Orthop 2014; 85:447-55. [PMID: 24954489 PMCID: PMC4164860 DOI: 10.3109/17453674.2014.934187] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Guidelines for standardization of radiostereometry (RSA) of implants were published in 2005 to facilitate comparison of outcomes between various research groups. In this systematic review, we determined how well studies have adhered to these guidelines. METHODS We carried out a literature search to identify all articles published between January 2000 and December 2011 that used RSA in the evaluation of hip or knee prosthesis migration. 2 investigators independently evaluated each of the studies for adherence to the 13 individual guideline items. Since some of the 13 points included more than 1 criterion, studies were assessed on whether each point was fully met, partially met, or not met. RESULTS 153 studies that met our inclusion criteria were identified. 61 of these were published before the guidelines were introduced (2000-2005) and 92 after the guidelines were introduced (2006-2011). The methodological quality of RSA studies clearly improved from 2000 to 2011. None of the studies fully met all 13 guidelines. Nearly half (43) of the studies published after the guidelines demonstrated a high methodological quality and adhered at least partially to 10 of the 13 guidelines, whereas less than one-fifth (11) of the studies published before the guidelines had the same methodological quality. Commonly unaddressed guideline items were related to imaging methodology, determination of precision from double examinations, and also mean error of rigid-body fitting and condition number cutoff levels. INTERPRETATION The guidelines have improved methodological reporting in RSA studies, but adherence to these guidelines is still relatively low. There is a need to update and clarify the guidelines for clinical hip and knee arthroplasty RSA studies.
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Affiliation(s)
- Rami Madanat
- Helsinki University Central Hospital, Helsinki,Harris Orthopaedic Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Hannu T Aro
- Turku University Hospital and University of Turku, Turku, Finland
| | - Charles Bragdon
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Henrik Malchau
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Arnoldi J, Alves A, Procter P. Early tissue responses to zoledronate, locally delivered by bone screw, into a compromised cancellous bone site: a pilot study. BMC Musculoskelet Disord 2014; 15:97. [PMID: 24656151 PMCID: PMC3994401 DOI: 10.1186/1471-2474-15-97] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 03/12/2014] [Indexed: 11/30/2022] Open
Abstract
Background In fracture treatment, adequate fixation of implants is crucial to long-term clinical performance. Bisphosphonates (BP), potent inhibitors of osteoclastic bone resorption, are known to increase peri-implant bone mass and accelerate primary fixation. However, adverse effects are associated with systemic use of BPs. Thus, Zoledronic acid (ZOL) a potent BP was loaded on bone screws and evaluated in a local delivery model. Whilst mid- to long-term effects are already reported, early cellular events occurring at the implant/bone interface are not well described. The present study investigated early tissue responses to ZOL locally delivered, by bone screw, into a compromised cancellous bone site. Methods ZOL was immobilized on fibrinogen coated titanium screws. Using a bilateral approach, ZOL loaded test and non-loaded control screws were implanted into femoral condyle bone defects, created by an overdrilling technique. Histological analyses of the local tissue effects such as new bone formation and osteointegration were performed at days 1, 5 and 10. Results Histological evaluation of the five day ZOL group, demonstrated a higher osseous differentiation trend. At ten days an early influx of mesenchymal and osteoprogenitor cells was seen and a higher level of cellular proliferation and differentiation (p < 5%). In the ZOL group bone-to-screw contact and bone volume values within the defect tended to increase. Local drug release did not induce any adverse cellular effects. Conclusion This study indicates that local ZOL delivery into a compromised cancellous bone site actively supports peri-implant osteogenesis, positively affecting mesenchymal cells, at earlier time points than previously reported in the literature.
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25
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Molt M, Harsten A, Toksvig-Larsen S. The effect of tourniquet use on fixation quality in cemented total knee arthroplasty a prospective randomized clinical controlled RSA trial. Knee 2014; 21:396-401. [PMID: 24238650 DOI: 10.1016/j.knee.2013.10.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Revised: 08/27/2013] [Accepted: 10/17/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND A concern that arises with any change in technique is whether it affects the long-term implant stability. The objective of this study was to evaluate the early migration, measured by radiostereometric analysis (RSA), and the functional outcome of the Triathlon™ cemented knee prosthesis, operated on with or without a tourniquet. During the last decades RSA has emerged as a way to assess prosthetic fixation and long time prognosis. The method has been used extensively in both hip and knee arthroplasty. METHOD This was a single centre prospective study including 60 patients randomized into two groups operated on either with or without tourniquet. RSA investigation was done within 2-3 days postoperatively after full weight bearing, and then at 3 months, 1 year and 2 years postoperatively. RESULTS There were no differences between the groups regarding the translation along or rotation around the three coordinal axes, or in maximum total point motion (MTPM). At 2 years the mean MTPM (SD) was 0.71 mm (0.64) for the tourniquet-group and 0.53 mm (0.21) for the non-tourniquet-group. CONCLUSIONS The tibial tray of the Triathlon™ cemented knee prosthesis showed similar early stability whether operated on with or without tourniquet. LEVEL OF EVIDENCE Level I. ARTICLE SUMMARY Article focus: A safety study for total knee replacement operated on with or without perioperative tourniquet regarding the prosthetic fixation. Strengths and limitations: Strength of this study is that it is a randomized prospective trial using an objective measuring tool. The sample size of 25-30 patients is reportedly sufficient for the screening of implants using RSA (1-3). TRIAL REGISTRATION Clinical trials NCT01604382, Ethics Committee approval D-nr: 144/20085.
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Affiliation(s)
- Mats Molt
- Department of Orthopaedics, Hässleholm-Kristianstad-Ystad, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden.
| | - Andreas Harsten
- Department of Anaesthesiology, Hässleholm Hospital, Hässleholm, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Sören Toksvig-Larsen
- Department of Orthopaedics, Hässleholm-Kristianstad-Ystad, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden
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Mathijssen NMC, Buma P, Hannink G. Combining bisphosphonates with allograft bone for implant fixation. Cell Tissue Bank 2013; 15:329-36. [DOI: 10.1007/s10561-013-9416-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 12/12/2013] [Indexed: 11/29/2022]
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Matuszewski Ł, Olchowik G, Mazurkiewicz T, Kowalczyk B, Zdrojewska A, Matuszewska A, Ciszewski A, Gospodarek M, Morawik I. Biomechanical parameters of the BP-enriched bone cement. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2013; 24:435-41. [PMID: 23670846 PMCID: PMC3990856 DOI: 10.1007/s00590-013-1230-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 04/28/2013] [Indexed: 12/31/2022]
Abstract
Bisphosphonates (BPs) are well-known substances with very efficient antiresorptive properties. Their beneficial actions are useful not only in achieving better bone mineral density but also in improving bone microarchitecture, strength and, consequently, its quality. Surgical cement, being a polymer composite, is required to be highly biocompatible and biotolerant. The goal of the presented study was to assess whether the enrichment of cement with pamidronate has changed its biomechanical properties. We compared the biomechanical parameters of clean bone cement and BP-enriched bone cement, which were both used formerly in our rat models. Biomechanical properties of BP-enriched bone cement are defined by two basic terms: stress and strain, which are caused by the influence of external force. In the investigatory process of the bone's biomechanical parameters, the compressive test and the three-point flexural tests were used. During the three-point flexural investigation, the sample was supported at both ends and loaded in the middle, resulting in a flexure. After a specific range of flexure, the sample was fractured. In obtained results, there were no significant differences in the values of the stress determined at the point of maximal load and the energy stored in the samples for proportional stress-strain limit (elastic region). There were also no significant differences in the density of the samples. The study shows that the enrichment of bisphosphonates causes yielding of the bone cement material. In the presented data, we conclude that use of pamidronate implanted in bone cement did not have a detrimental effect on its biomechanical properties. Therefore, the obtained results encouraged us to perform further in vivo experiments which assess the biomechanical properties of bones implanted with BP-enriched bone cement.
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Affiliation(s)
- Łukasz Matuszewski
- Pediatric Orthopedic and Rehabilitation Clinic, Medical University of Lublin, Ul. Chodźki 2, 21-093, Lublin, Poland,
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Irish J, Virdi AS, Sena K, McNulty MA, Sumner DR. Implant placement increases bone remodeling transiently in a rat model. J Orthop Res 2013; 31:800-6. [PMID: 23280449 DOI: 10.1002/jor.22294] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Accepted: 11/22/2012] [Indexed: 02/04/2023]
Abstract
To examine bone remodeling following implant placement, 88 female Sprague-Dawley rats underwent either sham ovariectomy (sham-ovx) or ovariectomy (ovx) at 4.5 months. At 11 months, 17 baseline control animals were euthanized, while 71 rats received bilateral intramedullary femoral implants. Implanted rats were randomized to 4-, 8-, or 12-week follow-up times. Microcomputed tomography was used to assess cortical area and trabecular architecture in all rats. Dynamic and static histomorphometry were performed in a subset to examine the trabecular and endocortical bone in the distal femoral metaphysis adjacent to the implant and the periosteal surface at the midshaft superior to the implant (n = 59). Implantation did not affect bone volume in either sham-ovx or ovx rats compared to baseline controls. Implant placement significantly increased mineralizing surface, mineral apposition rate, and bone formation rate in both sham-ovx and ovx rats at the trabecular and endocortical surfaces at four and sometimes 8 weeks, with a return to baseline values by 12 weeks. At the periosteal surface, implant placement increased bone formation at 4 weeks with a return to baseline levels by 8 weeks. Thus, implant placement increases bone remodeling transiently without affecting bone volume in sham-ovx and ovx rats.
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Affiliation(s)
- John Irish
- Department of Anatomy & Cell Biology, Rush University Medical Center, 600 South Paulina, Suite 507, Chicago, IL 60612, USA
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Molt M, Ljung P, Toksvig-Larsen S. Does a new knee design perform as well as the design it replaces? Bone Joint Res 2012; 1:315-23. [PMID: 23610663 PMCID: PMC3626188 DOI: 10.1302/2046-3758.112.2000064] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 10/09/2012] [Indexed: 11/17/2022] Open
Abstract
Objectives The objective of this study was to compare the early migration
characteristics and functional outcome of the Triathlon cemented
knee prosthesis with its predecessor, the Duracon cemented knee
prosthesis (both Stryker). Methods A total 60 patients were prospectively randomised and tibial
component migration was measured by radiostereometric analysis (RSA)
at three months, one year and two years; clinical outcome was measured
by the American Knee Society score and the Knee Osteoarthritis and
Injury Outcome Score. Results There were no statistically significant differences in rotation
or translation around or along the three coordinal axes, or in the
maximum total point motion (MTPM) during the two-year follow-up. Conclusions The Triathlon cemented knee prosthesis has similar early stability
and is likely to perform at least as well as the Duracon cemented
knee prosthesis over the longer term.
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Affiliation(s)
- M Molt
- Hässleholm Hospital, Orthopaedic Clinic Hässleholm - Kristianstad - Ystad, Box 351, 281 25 Hässleholm, Sweden
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Cattalini JP, Boccaccini AR, Lucangioli S, Mouriño V. Bisphosphonate-based strategies for bone tissue engineering and orthopedic implants. TISSUE ENGINEERING. PART B, REVIEWS 2012; 18:323-40. [PMID: 22440082 PMCID: PMC3458621 DOI: 10.1089/ten.teb.2011.0737] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2011] [Accepted: 03/20/2012] [Indexed: 01/24/2023]
Abstract
Bisphosphonates (BPs) are a group of well-established drugs that are applied in the development of metabolic bone disorder-related therapies. There is increasing interest also in the application of BPs in the context of bone tissue engineering, which is the topic of this review, in which an extensive overview of published studies on the development and applications of BPs-based strategies for bone regeneration is provided with special focus on the rationale for the use of different BPs in three-dimensional (3D) bone tissue scaffolds. The different alternatives that are investigated to address the delivery and sustained release of these therapeutic drugs in the nearby tissues are comprehensively discussed, and the most significant published approaches on bisphosphonate-conjugated drugs in multifunctional 3D scaffolds as well as the role of BPs within coatings for the improved fixation of orthopedic implants are presented and critically evaluated. Finally, the authors' views regarding the remaining challenges in the fields and directions for future research efforts are highlighted.
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Affiliation(s)
- Juan Pablo Cattalini
- Department of Pharmaceutical Technology, Faculty of Pharmacy and Biochemistry, University of Buenos Aires, Buenos Aires, Argentina
| | - Aldo R. Boccaccini
- Department of Materials Science and Engineering, Institute of Biomaterials, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Silvia Lucangioli
- National Science Research Council (CONICET), Buenos Aires, Argentina
- Department of Pharmaceutical Technology, Faculty of Pharmacy and Biochemistry, University of Buenos Aires, Buenos Aires, Argentina
| | - Viviana Mouriño
- National Science Research Council (CONICET), Buenos Aires, Argentina
- Department of Pharmaceutical Technology, Faculty of Pharmacy and Biochemistry, University of Buenos Aires, Buenos Aires, Argentina
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Ledin H, Aspenberg P, Good L. Tourniquet use in total knee replacement does not improve fixation, but appears to reduce final range of motion. Acta Orthop 2012; 83:499-503. [PMID: 22974220 PMCID: PMC3488177 DOI: 10.3109/17453674.2012.727078] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Although a tourniquet may reduce bleeding during total knee replacement (TKA), and thereby possibly improve fixation, it might also cause complications. Migration as measured by radiostereometric analysis (RSA) can predict future loosening. We investigated whether the use of a tourniquet influences prosthesis fixation measured with RSA. This has not been investigated previously to our knowledge. METHODS 50 patients with osteoarthritis of the knee were randomized to cemented TKA with or without tourniquet. RSA was performed postoperatively and at 6 months, 1 year, and 2 years. Pain during hospital stay was registered with a visual analog scale (VAS) and morphine consumption was measured. Overt bleeding and blood transfusions were registered, and total bleeding was estimated by the hemoglobin dilution method. Range of motion was measured up to 2 years. RESULTS RSA maximal total point motion (MTPM) differed by 0.01 mm (95% CI -0.13 to 0.15). Patients in the tourniquet group had less overt bleeding (317 mL vs. 615 mL), but the total bleeding estimated by hemoglobin dilution at day 4 was only slightly less (1,184 mL vs. 1,236 mL) with a mean difference of -54 mL (95% CI -256 to 152). Pain VAS measurements were lower in the non-tourniquet group (p = 0.01). There was no significant difference in morphine consumption. Range of motion was 11° more in the non-tourniquet group (p = 0.001 at 2 years). INTERPRETATION Tourniquet use did not improve fixation but it may cause more postoperative pain and less range of motion.
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Affiliation(s)
- Håkan Ledin
- Department of Orthopedics, Aleris Specialist Care, Motala
| | - Per Aspenberg
- Department of Orthopedics, Linköping University Hospital, Linköping
| | - Lars Good
- Department of Orthopedics, Oskarshamn Hospital, Oskarshamn, Sweden
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Daugaard H, Elmengaard B, Andreassen TT, Lamberg A, Bechtold JE, Soballe K. Systemic intermittent parathyroid hormone treatment improves osseointegration of press-fit inserted implants in cancellous bone. Acta Orthop 2012; 83:411-9. [PMID: 22880714 PMCID: PMC3427634 DOI: 10.3109/17453674.2012.702388] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Intermittent administration of parathyroid hormone (PTH) has an anabolic effect on bone, as confirmed in human osteoporosis studies, distraction osteogenesis, and fracture healing. PTH in rat models leads to improved fixation of implants in low-density bone or screw insertion transcortically. MATERIAL AND METHODS We examined the effect of human PTH (1-34) on the cancellous osseointegration of unloaded implants inserted press-fit in intact bone of higher animal species. 20 dogs were randomized to treatment with human PTH (1-34), 5 μg/kg/day subcutaneously, or placebo for 4 weeks starting on the day after insertion of a cylindrical porous coated plasma-sprayed titanium alloy implant in the proximal metaphyseal cancellous bone of tibia. Osseointegration was evaluated by histomorphometry and fixation by push-out test to failure. RESULTS Surface fraction of woven bone at the implant interface was statistically significantly higher in the PTH group by 1.4 fold with (median (interquartile range) 15% (13-18)) in the PTH group and 11% (7-13) in control. The fraction of lamellar bone was unaltered. No significant difference in bone or fibrous tissue was observed in the circumferential regions of 0-500, 500-1,000, and 1,000-2,000 μm around the implant. Mechanically, the implants treated with PTH showed no significant differences in total energy absorption, maximum shear stiffness, or maximum shear strength. INTERPRETATION Intermittent treatment with PTH (1-34) improved histological osseointegration of a prosthesis inserted press-fit at surgery in cancellous bone, with no additional improvement of the initial mechanical fixation at this time point.
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Affiliation(s)
- Henrik Daugaard
- Orthopaedic Research Laboratory, Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Brian Elmengaard
- Orthopaedic Research Laboratory, Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | | | - Anders Lamberg
- Orthopaedic Research Laboratory, Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Joan Elisabeth Bechtold
- Orthopaedic Biomechanics Laboratory, Excelen Center for Bone and Joint Research and Minneapolis Medical Research Foundation, Minneapolis, MN, USA
| | - Kjeld Soballe
- Orthopaedic Research Laboratory, Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark
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Papavasiliou KA, Nikopoulou A, Kenanidis EI, Potoupnis ME, Kyrkos MJ, Sayegh FE, Kapetanos GA. Serum intact-parathyroid hormone level following total knee arthroplasty. J Orthop Surg (Hong Kong) 2012; 20:27-31. [PMID: 22535807 DOI: 10.1177/230949901202000106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To evaluate short-term parathyroid hormone (PTH) secretion following total knee arthroplasty (TKA). METHODS 119 Caucasian postmenopausal women aged 49 to 81 (mean, 69.8) years who underwent TKA for end-stage knee osteoarthritis were included. Serum levels of intact-PTH, calcium, phosphorus, and creatinine were evaluated pre- and post-operatively (on days -1 and 7). Creatinine clearance was also calculated. RESULTS In 67 of the patients, serum intact-PTH levels decreased after TKA; this sample proportion was not significant (p=0.82). In 16 of the patients, such levels elevated abnormally (above normal range). In the remaining 36 patients, such levels elevated within the normal range. Therefore, the mean serum intact- PTH level of all patients increased slightly after TKA (45.4 vs. 45.3, p=0.162). The serum intact-PTH level did not correlate to body weight (r=-0.045, p=0.624), patient age (r=-0.061, p=0.508), serum creatinine level (r=0.084, p=0.366), and clearance of creatinine (r=-0.037, p=0.692). CONCLUSION In most postmenopausal women, the serum intact-PTH level decreased moderately following TKA, but in some, the level was abnormally elevated. This may interfere the prosthesis incorporation process.
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Affiliation(s)
- Kyriakos A Papavasiliou
- 3rd Orthopaedic Department, Aristotle University of Thessaloniki-Medical School, Papageorgiou General Hospital, Thessaloniki, Greece.
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Impregnation of bone chips with alendronate and cefazolin, combined with demineralized bone matrix: a bone chamber study in goats. BMC Musculoskelet Disord 2012; 13:44. [PMID: 22443362 PMCID: PMC3338367 DOI: 10.1186/1471-2474-13-44] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 03/24/2012] [Indexed: 11/26/2022] Open
Abstract
Background Bone grafts from bone banks might be mixed with bisphosphonates to inhibit the osteoclastic response. This inhibition prevents the osteoclasts to resorb the allograft bone before new bone has been formed by the osteoblasts, which might prevent instability. Since bisphosphonates may not only inhibit osteoclasts, but also osteoblasts and thus bone formation, we studied different bisphosphonate concentrations combined with allograft bone. We investigated whether locally applied alendronate has an optimum dose with respect to bone resorption and formation. Further, we questioned whether the addition of demineralized bone matrix (DBM), would stimulate bone formation. Finally, we studied the effect of high levels of antibiotics on bone allograft healing, since mixing allograft bone with antibiotics might reduce the infection risk. Methods 25 goats received eight bone conduction chambers in the cortical bone of the proximal medial tibia. Five concentrations of alendronate (0, 0.5 mg/mL, 1 mg/mL, 2 mg/mL, and 10 mg/mL) were tested in combination with allograft bone and supplemented with cefazolin (200 μg/mL). Allograft not supplemented with alendronate and cefazolin served as control. In addition, allograft mixed with demineralized bone matrix, with and without alendronate, was tested. After 12 weeks, graft bone area and new bone area were determined with manual point counting. Results Graft resorption decreased significantly (p < 0.001) with increasing alendronate concentration. The area of new bone in the 1 mg/mL alendronate group was significantly (p = 0.002) higher when compared to the 10 mg/mL group. No differences could be observed between the group without alendronate, but with demineralized bone, and the control groups. Conclusions A dose-response relationship for local application of alendronate has been shown in this study. Most new bone was present at 1 mg/mL alendronate. Local application of cefazolin had no effect on bone remodelling.
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Sköldenberg OG, Salemyr MO, Bodén HS, Ahl TE, Adolphson PY. 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 2011; 93:1857-64. [PMID: 22012522 DOI: 10.2106/jbjs.j.01646] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Bone loss leading to late-occurring periprosthetic femoral fracture is a mode of failure in cementless total hip arthroplasty. The aim of this trial was to investigate the effect of a bisphosphonate, risedronate, on femoral periprosthetic bone resorption following total hip arthroplasty in patients with osteoarthritis of the hip. METHODS We enrolled seventy-three patients between the ages of forty and seventy years who were scheduled to undergo total hip arthroplasty in a single-center, randomized, double-blind, placebo-controlled trial. Subjects were randomly assigned to receive either 35 mg of risedronate (n = 36) or a placebo (n = 37) orally once weekly for six months. The primary end point was the change in bone mineral density in Gruen femoral zones 1 and 7. Bone mineral density scans were made preoperatively and at two days and three, six, twelve, and twenty-four months postoperatively. Secondary end points included migration of the femoral stem and clinical outcome. RESULTS Seventy of the seventy-three patients (thirty-three in the risedronate group and thirty-seven in the placebo group) were analyzed for the primary end point. The mean bone mineral density in zone 1 was 9.2% higher (95% confidence interval [CI], 4.2% to 14.1%) in the risedronate group than in the placebo group at six months postoperatively and 7.2% higher (95% CI, 1.0% to 13.3%) at one year. The mean bone mineral density in zone 7 was 8.0% higher (95% CI, 2.7% to 13.4%) in the risedronate group than in the placebo group at six months postoperatively and 4.3% higher (95% CI, -1.5% to 10.1%) at one year. Migration of the femoral stem, the clinical outcome, and the frequency of adverse events did not differ between the groups. CONCLUSIONS Risedronate taken once weekly for six months following total hip arthroplasty was effective in reducing periprosthetic bone resorption around an uncemented femoral stem up to one year after surgery but had no discernible effect on implant migration or clinical outcome. Future studies of bisphosphonate treatment following total hip arthroplasty should focus on clinically relevant end points such as the risks of fracture and revision arthroplasty.
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Affiliation(s)
- Olof Gustaf Sköldenberg
- Division of Orthopaedics, Department of Clinical Sciences at Danderyd Hospital, Karolinska Institute, Danderyds Sjukhus, 18288 Stockholm, Sweden.
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Wilkinson JM, Little DG. Bisphosphonates in orthopedic applications. Bone 2011; 49:95-102. [PMID: 21256254 DOI: 10.1016/j.bone.2011.01.009] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2010] [Revised: 01/11/2011] [Accepted: 01/12/2011] [Indexed: 02/08/2023]
Abstract
Bisphosphonates (BPs) exert potent effects on the skeleton. As such, there are important questions relating to how treatment with BPs for metabolic disorders might affect outcomes of orthopedic problems. A further question is what role, if any, might BPs play as adjunctive therapeutics for orthopedic problems. This article outlines the research thus far in the application of BPs to the management of osteonecrosis, bone repair, and joint arthroplasty. Many animal studies show a benefit to decreasing bone resorption in models of osteonecrosis. These include studies in both small and large animals, backed up by limited human data. Further clinical trials are underway for this indication. In bone repair, again, multiple studies exist. There are concerns that BPs could interfere with the normal processes of healing. Some of the controversy about benefits or adverse effects of BPs in this context can be distilled down to effects of dosing and administration. With some exceptions, longer intervals between dosing seem to be more beneficial while not producing adverse healing effects in animal studies. In joint arthroplasty, animal studies suggest a role for topical or systemic BPs for enhancing bone on-growth to implant surfaces and strength of mechanical fixation, although these are yet to be confirmed in clinical studies. Clinical studies show that BPs inhibit periprosthetic bone loss due to strain-adaptive remodeling and after impaction bone grafting, although an efficacy in inhibiting inflammatory bone loss due to wear particle-induced osteolysis has not been confirmed. Lastly, as anabolic drugs have become available, there is increasing interest in their combined use with BPs. From experimental data, manipulation of both the anabolic and catabolic responses is a powerful approach in models of bone repair.
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Affiliation(s)
- J Mark Wilkinson
- Academic Unit of Bone Metabolism, Department of Human Metabolism, University of Sheffield, Metabolic Bone Centre, Sorby Wing, Northern General Hospital, Sheffield, UK.
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McKenzie K, Dennis Bobyn J, Roberts J, Karabasz D, Tanzer M. Bisphosphonate remains highly localized after elution from porous implants. Clin Orthop Relat Res 2011; 469:514-22. [PMID: 20809167 PMCID: PMC3018218 DOI: 10.1007/s11999-010-1527-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Local elution of zoledronic acid from a porous implant reportedly enhances periimplant bone formation and implant fixation. However, there is no information in the literature on the extent to which eluted bisphosphonate remains localized around the implant or becomes systemically distributed. QUESTIONS/PURPOSES We ascertained to what extent eluted zoledronic acid remains local and whether there is systemic exposure after local elution from porous implants. METHODS A hydroxyapatite-coated porous tantalum implant dosed with 100 μg (14)C-labeled zoledronic acid was implanted into the left femoral intramedullary canal of six dogs. Bone samples near to and distant from the implant were harvested from three dogs at 6 weeks and three dogs at 52 weeks. The concentration of radiolabeled bisphosphonate in each sample was quantified using liquid scintillation spectrophotometry and its distribution in periimplant bone was revealed by exposing histologic sections to autoradiography film. RESULTS In all six dogs, the concentration of zoledronic acid in immediate periimplant bone was two orders of magnitude higher than in any other sampled tissue, averaging 732.6 ng/g at 6 weeks and 377.2 ng/g at 52 weeks. Minute amounts of zoledronic acid (≤ 7.2 ng/g) were detected throughout the skeleton, indicating some escape into the circulation after local elution. Autoradiographs revealed the greatest concentration of zoledronic acid on and within the implant, with rapid decrease short distances away and no uptake within the femoral cortex. CONCLUSIONS Zoledronic acid eluted from an implant remains mainly localized with minimal systemic distribution. CLINICAL RELEVANCE Local bisphosphonate elution reduces the risk of systemic side effects and skeletal bisphosphonate exposure.
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Affiliation(s)
- Kimberly McKenzie
- Jo Miller Orthopaedic Research Laboratory, Montreal General Hospital, Montreal, Canada
| | - J. Dennis Bobyn
- Jo Miller Orthopaedic Research Laboratory, Montreal General Hospital, Montreal, Canada ,Division of Orthopaedics, McGill University, 1650 Cedar Avenue, Rm LS1-409, Montreal, QC H3G1A4 Canada
| | - Jacintha Roberts
- Jo Miller Orthopaedic Research Laboratory, Montreal General Hospital, Montreal, Canada
| | - Dorota Karabasz
- Jo Miller Orthopaedic Research Laboratory, Montreal General Hospital, Montreal, Canada
| | - Michael Tanzer
- Jo Miller Orthopaedic Research Laboratory, Montreal General Hospital, Montreal, Canada
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Kenanidis EI, Potoupnis ME, Papavasillioul KA, Sayegh FE, Petsatodis GE, Kapetanos GA. Serum levels of bone turnover markers following total joint arthroplasty. J Orthop Surg (Hong Kong) 2010; 18:290-5. [PMID: 21187538 DOI: 10.1177/230949901001800307] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To evaluate changes in serum levels of bone turnover markers during the first year following a total hip or knee arthroplasty (THA or TKA, respectively). METHODS 34 women and 13 men (mean age, 68 years) with idiopathic hip or knee osteoarthritis underwent elective THA or TKA. The serum levels of (1) osteoprotegerin, (2) nuclear factor-kappa B ligand (RANKL), (3) osteocalcin, and (4) bone-specific alkaline phosphatase (b-ALP) were determined in each patient on preoperative day 1 and postoperative day 3 and 7, and month 2, 4, 6, 8, 10, and 12. RESULTS All 4 markers changed significantly over the 12-month period. At month 12, values of all markers did not return to their preoperative levels uniformly. At month 8, the serum levels of osteoprotegerin, osteocalcin, and b-ALP remained higher than their respective preoperative values. The serum levels of RANKL gradually decreased after month 2, rendering this marker a potential index for fixation. CONCLUSIONS Bone turnover markers change following arthroplasties. Postoperative month 8 seems to be a milestone in the normal course of these markers.
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Affiliation(s)
- Eustathios I Kenanidis
- 3rd Orthopaedic Department, Aristotle University of Thessaloniki-Medical School, Papageorgiou General Hospital, Thessaloniki, Greece.
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Fahlgren A, Bostrom MPG, Yang X, Johansson L, Edlund U, Agholme F, Aspenberg P. Fluid pressure and flow as a cause of bone resorption. Acta Orthop 2010; 81:508-16. [PMID: 20718695 PMCID: PMC2917576 DOI: 10.3109/17453674.2010.504610] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Unstable implants in bone become surrounded by an osteolytic zone. This is seen around loose screws, for example, but may also contribute to prosthetic loosening. Previous animal studies have shown that such zones can be induced by fluctuations in fluid pressure or flow, caused by implant instability. METHOD To understand the roles of pressure and flow, we describe the 3-dimensional distribution of osteolytic lesions in response to fluid pressure and flow in a previously reported rat model of aseptic loosening. 50 rats had a piston inserted in the proximal tibia, designed to produce 20 local spikes in fluid pressure of a clinically relevant magnitude (700 mmHg) twice a day. The spikes lasted for about 0.3 seconds. After 2 weeks, the pressure was measured in vivo, and the osteolytic lesions induced were studied using micro-CT scans. RESULTS Most bone resorption occurred at pre-existing cavities within the bone in the periphery around the pressurized region, and not under the piston. This region is likely to have a higher fluid flow and less pressure than the area just beneath the piston. The velocity of fluid flow was estimated to be very high (roughly 20 mm/s). INTERPRETATION The localization of the resorptive lesions suggests that high-velocity fluid flow is important for bone resorption induced by instability.
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Affiliation(s)
- Anna Fahlgren
- Division of Orthopaedics, Department of Clinical and Experimental Medicine, Linköping University, LinköpingSweden,Correspondence:
| | | | - Xu Yang
- Hospital for Special Surgery, New York, NYUSA
| | - Lars Johansson
- Division of Mechanics, Department of Management and Enineering, Linköping University, LinköpingSweden
| | - Ulf Edlund
- Division of Mechanics, Department of Management and Enineering, Linköping University, LinköpingSweden
| | - Fredrik Agholme
- Division of Orthopaedics, Department of Clinical and Experimental Medicine, Linköping University, LinköpingSweden
| | - Per Aspenberg
- Division of Orthopaedics, Department of Clinical and Experimental Medicine, Linköping University, LinköpingSweden
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Thillemann TM, Pedersen AB, Mehnert F, Johnsen SP, Søballe K. Postoperative use of bisphosphonates and risk of revision after primary total hip arthroplasty: a nationwide population-based study. Bone 2010; 46:946-51. [PMID: 20102756 DOI: 10.1016/j.bone.2010.01.377] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Revised: 01/20/2010] [Accepted: 01/21/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Recently, bisphosphonates have been linked with mechanisms that may influence longevity of orthopedic implants. We therefore evaluated the association between the use of bisphosphonates and the risk of revision after primary total hip arthroplasty (THA). METHODS We conducted a nationwide population-based nested case-control study using medical databases in Denmark. From the Danish Hip Arthroplasty Register (DHR) we included primary THA patients diagnosed with either osteoporosis or a previous osteoporotic fracture (n=16,145). Among these patients we identified 632 cases that were revised after primary THA in the period 1995-2006. The cases were matched on gender, age and year of primary THA surgery with 1262 non-revised osteoporotic THA controls. Using conditional logistic regression we estimated the risk of revision due to all causes and due to specific causes according to postoperative bisphosphonate use. RESULTS The 10-year cumulated implant revision rate in the underlying cohort of 16,145 primary THA procedures among osteoporotic patients was 8.3% (95% confidence interval (CI): 7.3-9.3). The use of bisphosphonates was associated with an adjusted relative risk of revision due to deep infections of 2.59 (95% CI; 1.30-6.53). Further, the duration of bisphosphonates use up to 120days, 120 and 240days, and more than 240days was associated with adjusted relative risks of revision due to all causes of 2.77 (95% CI; 1.65-4.64), 1.33 (95% CI; 0.63-2.72), and 0.58 (95% CI; 0.32-1.05) respectively. CONCLUSIONS The use of bisphosphonates following primary THA was associated with an increased risk of revision due to deep infection. However, long-term use was associated with a reduced risk of revision of any type. Further research is warranted in order to clarify whether these associations are truly causal.
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Affiliation(s)
- Theis M Thillemann
- Department of Orthopedics, Aarhus University Hospital, Denmark; Department of Clinical Epidemiology, Aarhus University Hospital, Denmark.
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Papavasiliou KA, Kenanidis EI, Potoupnis ME, Sarris IK, Kirkos JM, Kapetanos GA. Incidence of secondary hyperparathyroidism among postmenopausal women with end-stage knee osteoarthritis. J Orthop Surg (Hong Kong) 2009; 17:310-2. [PMID: 20065370 DOI: 10.1177/230949900901700313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To evaluate the incidence of secondary hyperparathyroidism (SH) among postmenopausal women with end-stage knee osteoarthritis scheduled for total knee replacement (TKR). METHODS 283 Caucasian postmenopausal women aged 49 to 81 (mean, 70) years with end-stage idiopathic knee osteoarthritis were scheduled to undergo primary TKR. They had been menopausal for 7 to 31 (mean, 19) years. Their preoperative serum levels of intact parathyroid hormone (I-PTH), calcium, phosphorus, creatinine, and the clearance of creatinine were evaluated. RESULTS 100 patients had abnormally elevated serum I-PTH. The overall incidence of SH was 35%. Serum levels of calcium and phosphorus were elevated in 33 and 12 patients, respectively. The serum level of I-PTH correlated positively with patient age (r=0.158, p=0.008) and serum creatinine level (r=0.138, p=0.021) and negatively with clearance of creatinine (r= -0.169, p=0.004). CONCLUSION SH is common among elderly postmenopausal women and may affect bone healing and implant fixation. Preoperative screening/evaluation of the serum PTH level in postmenopausal women scheduled for TKR is recommended.
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Affiliation(s)
- Kyriakos A Papavasiliou
- 3rd Orthopaedic Department, Medical School of the Aristotle University of Thessaloniki, Greece.
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Bobyn JD, McKenzie K, Karabasz D, Krygier JJ, Tanzer M. Locally delivered bisphosphonate for enhancement of bone formation and implant fixation. J Bone Joint Surg Am 2009; 91 Suppl 6:23-31. [PMID: 19884409 DOI: 10.2106/jbjs.i.00518] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Can we improve fixation and outcomes in the treatment of femoral neck fractures? The use of pharmaceuticals. J Orthop Trauma 2009; 23:413-21. [PMID: 19550227 DOI: 10.1097/bot.0b013e3181ac64a0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Femoral neck fracture rates are on the rise with an estimated 500,000 occurring annually by 2040. Despite the mainstay of open reduction and internal fixation, nonunion rates of up to 33% have been reported for displaced femoral neck fractures. Recently, increasing attention has been focused upon the role of osteobiologics to stimulate fracture repair. This article looks at the role of these anabolic compounds and discusses their potential future roles in augmenting the treatment of this condition.
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Xue Q, Li H, Zou X, Dalstra M, Lind M, Christensen FB, Bünger C. Alendronate treatment improves bone-pedicle screw interface fixation in posterior lateral spine fusion: an experimental study in a porcine model. INTERNATIONAL ORTHOPAEDICS 2009; 34:447-51. [PMID: 19330331 DOI: 10.1007/s00264-009-0759-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2008] [Revised: 02/25/2009] [Accepted: 03/01/2009] [Indexed: 11/30/2022]
Abstract
The bone-screw interface has been indicated as the weak link in pedicle screw spine fixation. Bisphosphonate treatment may have the effect of improving bone-screw interface fixation in spine fusion by inhibiting bone resorption. An experimental study was conducted using a porcine model to evaluate the influence of alendronate treatment on bone-pedicle screw interface fixation. Eleven pigs in the treatment group received alendronate 10 mg/day orally for three months postoperatively. The other 11 pigs served as a control group. Posterior lateral fusion with the CD Horizon pedicle screw system was performed with autograft on the lumbar spine on all animals. Biomechanical torsion test and histomorphometric parameters of screw fixation were evaluated three months after the operation. The maximum torque and initial angular stiffness of the treatment group was higher than that of the control group, but there was no statistical significance. The bone-screw contact surface was 23.3 +/- 10% for the treatment group and 9.8 +/- 5.9% for the control group (P < 0.01). This study indicated that alendronate treatment increased bone purchase of stainless steel screw surfaces.
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Affiliation(s)
- Qingyun Xue
- Orthopaedic Research Laboratory, Orthopedic Department, Spine Section E, Institute of Experimental Clinical Research, Aarhus University Hospital, Aarhus, Denmark.
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Meunier A, Aspenberg P, Good L. Celecoxib does not appear to affect prosthesis fixation in total knee replacement: A randomized study using radiostereometry in 50 patients. Acta Orthop 2009; 80:46-50. [PMID: 19234885 PMCID: PMC2823240 DOI: 10.1080/17453670902804976] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND AND PURPOSE After joint replacement, a repair process starts at the interface between bone and cement. If this process is disturbed, the prosthesis may never become rigidly fixed to the bone, leading to migration-and with time, loosening. Cox-2 inhibitors are widely used as postoperative analgesics, and have adverse effects on bone healing. This could tamper prosthesis fixation. We investigated whether celecoxib, a selective Cox-2 inhibitor, increases prosthesis migration in total knee replacement (TKR). METHODS 50 patients were randomized to either placebo or celecoxib treatment, 200 mg twice daily, for 3 weeks after TKR (NexGen; Zimmer). Maximum total point motion (MTPM) of the tibial component was measured after 2 years using radiostereometric analysis (RSA). In addition, range of motion, pain, and, subjective outcome were evaluated. RESULTS No differences in prosthesis migration, pain scores, range of motion, and subjective outcome were found after 2 years. Confidence intervals were narrow. INTERPRETATION It is unlikely that Celecoxib increases the risk of loosening, and it may be used safely in conjunction with TKR.
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Affiliation(s)
- Per Aspenberg
- 1Orthopaedics Section, Department of Clinical and Experimental Medicine, Linköping UniversityLinköpingSweden
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Hansson U, Toksvig-Larsen S, Ryd L, Aspenberg P. Once-weekly oral medication with alendronate does not prevent migration of knee prostheses: A double-blind randomized RSA study. Acta Orthop 2009; 80:41-5. [PMID: 19297788 PMCID: PMC2823246 DOI: 10.1080/17453670902804968] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND AND PURPOSE Early migration of joint replacements is an effect of poor fixation and can predict late loosening. By reducing the bone resorption after implantation of a joint replacement, it should be possible to enhance the initial fixation of the implant. We studied the effect of once-weekly treatment with alendronate after knee replacement. PATIENTS AND METHODS We recruited 60 patients (60 knees) with gonarthrosis who were scheduled for a total knee replacement. They were operated on with identical implants and uncemented fixation. 30 patients were treated with a bisphosphonate (alendronate) and 30 patients underwent placebo treatment. The treatment started postoperatively and continued on a weekly basis for 6 months. The fixation of the implants was measured with repeated radiostereometry for 2 years. RESULTS There was no difference in migration of implants between the two groups. CONCLUSION With uncemented fixation of knee implants, no benefit of once-weekly treatment with alendronate, starting postoperatively, could be seen during a 2-year follow-up period.
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Affiliation(s)
- Ulrik Hansson
- 1Department of Orthopedics, Lund University HospitalLundSweden
| | | | - Leif Ryd
- 2Department of Orthopedics, Karolinska University HospitalHuddingeSweden
| | - Per Aspenberg
- 3Department of Orthopedics, Linköping University HospitalLinköpingSweden
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Hansson U, Ryd L, Toksvig-Larsen S. A randomised RSA study of Peri-Apatite HA coating of a total knee prosthesis. Knee 2008; 15:211-6. [PMID: 18329882 DOI: 10.1016/j.knee.2008.01.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2007] [Revised: 01/07/2008] [Accepted: 01/10/2008] [Indexed: 02/02/2023]
Abstract
BACKGROUND In total knee replacement, sound early fixation of the prosthesis is crucial for achieving a good long-term result and for minimising the risk of loosening. Various types of prosthetic material, different surface textures and shapes and the incorporation of screws or pegs have been used to achieve good fixation, particularly in the uncemented knee. Hydroxyapatite (HA) coating of prosthetic joint components is another technique used to enhance early stability and so to improve the longevity of the prosthesis-bone fixation. HA ceramic coatings are mostly plasma sprayed onto the fixation surface of the implant. Plasma spraying is largely a 'line of sight' technique and as such there are difficulties involved when covering three-dimensional planes, such as porous beaded fixation surfaces typically found on several knee prostheses. The objective of this study was to assess the clinical performance of the solution-deposited HA coating, Peri-Apatite , with regard to its ability to stimulate an endurable and stable implant fixation. PATIENTS AND METHODS We randomised 60 patients into two groups; one group received the porous coated prosthesis with solution-deposited HA, and the other group received a prosthesis without HA. Radiostereometric examination was used as the primary tool for measuring migration in the prosthetic components. RESULTS There was a lower incidence of early subsidence in the Peri-Apatite group. At 24 months there were no differences in clinical scorings or maximal total point motion. CONCLUSION Addition of solution-deposited HA coating appears to provide better early stable fixation in a porous coated knee prosthesis.
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Affiliation(s)
- Ulrik Hansson
- Department of Orthopaedics, Lund University Hospital, 22185 Lund, Sweden.
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Kaufman AM, Alabre CI, Rubash HE, Shanbhag AS. Human macrophage response to UHMWPE, TiAlV, CoCr, and alumina particles: analysis of multiple cytokines using protein arrays. J Biomed Mater Res A 2008; 84:464-74. [PMID: 17618502 DOI: 10.1002/jbm.a.31467] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Aseptic loosening of total joint replacements is believed to be initiated by a macrophage response to prosthetic wear debris. To better characterize the early response to clinically relevant wear debris, we challenged primary human macrophages from four donors with ultra high molecular weight polyethylene (UHMWPE), TiAlV, CoCr, and alumina particles. After a 24-h culture, protein arrays were used to quantify the secretion of 30 different cytokines and chemokines. Macrophages secreted detectable levels of nine mediators in culture: Interleukin-1alpha (IL-1alpha), tumor necrosis factor-alpha (TNF-alpha), IL-1beta, MCP-1, IL-8, IL-6, GM-CSF, IL-10, and IL-12p40. TiAlV particles were the most stimulatory, causing 5- to 900-fold higher cytokine expression compared with nonstimulated cells and uniquely eliciting high levels of IL-1alpha, IL-6, IL-10, and GM-CSF. CoCr and alumina were mildly stimulatory and typically elicited two- to fivefold greater levels than nonstimulated cells. Surprisingly, UHMWPE did not elicit a significant increase in cytokine release. Our data suggests that IL-1alpha, TNF-alpha, IL-1beta, and MCP-1 are the primary initiators of osteolysis and implicates metallic debris as an important trigger for their release.
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Affiliation(s)
- Adam M Kaufman
- Biomaterials Lab, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02474, USA
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