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Tang Y, Jin Z, Lu Y, Chen L, Lv S, Xu T, Tong P, Chen G. Comparing the Efficacy of Antiosteoporotic Drugs in Preventing Periprosthetic Bone Loss Following Total Hip Arthroplasty: A Systematic Review and Bayesian Network Meta-Analysis. Orthop Surg 2024. [PMID: 39056482 DOI: 10.1111/os.14165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 06/15/2024] [Accepted: 06/24/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Periprosthetic bone loss is a well-known phenomenon following total hip arthroplasty (THA). However, the choice of drugs for prevention remains controversial. Therefore, the aim of this study was to determine the best drug to treat periprosthetic bone loss by comparing changes in bone mineral density (BMD) at different times after THA. METHODS A comprehensive search of five databases and two clinical trial registration platforms was undertaken from their inception through to August 31, 2023 to identify eligible randomized controlled trials. A Bayesian network meta-analysis (NMA) was carried out for calculating the standardized mean difference (SMD) and the surface under cumulative ranking curve (SUCRA) of the BMD in calcar (Gruen zone 7) at 6 months, 12 months, and 24 months and over. RESULTS Twenty-nine trials involving 1427 patients and 10 different interventions were included. The results demonstrated that at 6 months, denosumab had the highest ranking (SUCRA = 0.90), followed by alendronate (SUCRA = 0.76), and zoledronate (SUCRA = 0.73). At 12 months, clodronate ranked highest (SUCRA = 0.96), followed by denosumab (SUCRA = 0.84) and teriparatide (SUCRA = 0.82). For interventions with a duration of 24 months and over, denosumab had the highest SUCRA value (SUCRA = 0.96), followed by raloxifene (SUCRA = 0.90) and zoledronate (SUCRA = 0.75). CONCLUSION Investigating the existing body of evidence revealed that denosumab demonstrates potential as an intervention of superior efficacy at the three specifically examined time points. However, it remains crucial to conduct further research to confirm these findings and determine the most effective treatment strategy.
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Affiliation(s)
- Yi Tang
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Zhejiang, China
| | - Zhaokai Jin
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Zhejiang, China
| | - Yichen Lu
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Zhejiang, China
| | - Lei Chen
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Zhejiang, China
| | - Shuaijie Lv
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Zhejiang, China
| | - Taotao Xu
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Zhejiang, China
| | - Peijian Tong
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Zhejiang, China
| | - Guoqian Chen
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Zhejiang, China
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Kuyl EV, Agarwal AR, Patel PK, Harris AB, Gu A, Rao S, Thakkar SC, Golladay GJ. Osteoporotic Patients Undergoing Total Hip Arthroplasty Have a Similar 5-Year Cumulative Incidence Rate of Periprosthetic Fracture Regardless of Cemented Versus Cementless Femoral Stem Fixation. J Arthroplasty 2024; 39:1285-1290.e1. [PMID: 37952741 DOI: 10.1016/j.arth.2023.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/30/2023] [Accepted: 11/04/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND In osteoporotic patients, surgeons may utilize cemented femoral fixation to minimize risk of fracture. The purpose of this study was to compare 5-year implant survivability in patients who have osteoporosis who underwent elective total hip arthroplasty (THA) with cementless versus cemented fixation. METHODS A retrospective analysis of patients who have osteoporosis undergoing THA with either cemented or cementless femoral fixation was conducted using a national administrative claims database. Of the 18,431 identified THA patients who have osteoporosis, 15,867 (86.1%) underwent cementless fixation. The primary outcome was a comparison of the 5-year cumulative incidences of aseptic revision, mechanical loosening, and periprosthetic fracture (PPF). Kaplan-Meier and Multivariable Cox Proportional Hazard Ratio analyses were used, controlling for femoral fixation method, age, sex, a comorbidity scale, use of osteoporosis medication, and important comorbidity. RESULTS There was no difference in aseptic revision (Hazard's Ratio (HR): 1.13; 95% Confidence Interval (CI): 0.79 to 1.62; P value: .500) and PPF (HR: 0.96; 95% CI: 0.64 to 1.44; P value: .858) within 5 years of THA between fixation cohorts. However, patients who had cemented fixation were more likely to suffer mechanical loosening with 5 years post-THA (HR: 1.79; 95% CI: 1.17 to 2.71; P-value: .007). CONCLUSIONS We found a similar 5-year rate of PPF when comparing patients who underwent cementless versus cemented femoral fixation for elective THA regardless of preoperative diagnosis of osteoporosis. While existing registry data support the use of cemented fixation in elderly patients, a more thorough understanding of the interplay between age, osteoporosis, and implant design is needed to delineate in whom cemented fixation is most warranted for PPF prevention.
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Affiliation(s)
- Emile-Victor Kuyl
- Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Amil R Agarwal
- Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Parth K Patel
- Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Andrew B Harris
- Department of Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, Maryland
| | - Alex Gu
- Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Sandesh Rao
- Washington Orthopaedics and Sports Medicine, Washington, District of Columbia
| | | | - Gregory J Golladay
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, Virginia
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Hatano M, Koizumi Y, Yamamoto N, Miyoshi K, Kawabata K, Tanaka T, Tanaka S, Shiroshita A, Kataoka Y. Anti-osteoporotic drug efficacy for periprosthetic bone loss after total hip arthroplasty: A systematic review and network meta-analysis. J Orthop Sci 2024:S0949-2658(24)00012-5. [PMID: 38342711 DOI: 10.1016/j.jos.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/18/2024] [Accepted: 01/30/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND Periprosthetic bone loss following total hip arthroplasty (THA) threatens prosthesis stability. This systematic review and network meta-analysis aimed to compare the efficacy of anti-osteoporotic drugs for measures of hip function according to functional outcomes, periprosthetic femoral bone mineral density loss in each Gruen zone, and revision surgery after THA. METHODS The systematic search of six literature databases was conducted in December 2021 in accordance with PRISMA guidelines. Adult participants who underwent primary THA were included. A random-effects network meta-analysis was performed within a frequentist framework, and the confidence in the evidence for each outcome was evaluated using the CINeMA tool, which assessed the credibility of results from the network meta-analysis. We included 22 randomized controlled trials (1243 participants) comparing the efficacy and safety of bisphosphonates (including etidronate, clodronate, alendronate, risedronate, pamidronate, and zoledronate), denosumab, selective estrogen receptor modulator, teriparatide, calcium + vitamin D, calcium, and vitamin D. We defined the period for revision surgery as the final follow-up period. RESULTS Raloxifene, bisphosphonate, calcium + vitamin D, and denosumab for prosthetic hip function might have minimal differences when compared with placebos. The magnitude of the anti-osteoporotic drug effect on periprosthetic femoral bone loss varied across different Gruen zones. Bisphosphonate, denosumab, teriparatide might be more effective than placebo in Gruen zone 1 at 12 months after THA. Additionally, bisphosphonate might be more effective than placebo in Gruen zones 2, 5, 6, and 7 at 12 months after THA. Denosumab was efficacious in preventing bone loss in Gruen zones 6 and 7 at 12 months after THA. Teriparatide was likely to be efficacious in preventing bone loss in Gruen zone 7 at 12 months after THA. Raloxifene was slightly efficacious in preventing bone loss in Gruen zones 2 and 3 at 12 months after THA. Calcium was slightly efficacious in preventing bone loss in Gruen zone 5 at 12 months after THA. None of the studies reported revision surgery. CONCLUSIONS Bisphosphonate and denosumab may be effective anti-osteoporotic drugs for preventing periprosthetic proximal femoral bone loss due to stress shielding after THA, particularly in cementless proximal fixation stems, which are the most commonly used prostheses worldwide.
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Affiliation(s)
- Masaki Hatano
- Department of Orthopaedic and Spine Surgery, Yokohama Rosai Hospital, 3-2-1-1 Kozukue, Kohoku-ku, Kanagawa 222-0036, Japan; Scientific Research Works Peer Support Group (SRWS-PSG), Osaka, Japan
| | - Yasuhiko Koizumi
- Department of Orthopaedic and Spine Surgery, Yokohama Rosai Hospital, 3-2-1-1 Kozukue, Kohoku-ku, Kanagawa 222-0036, Japan
| | - Norio Yamamoto
- Scientific Research Works Peer Support Group (SRWS-PSG), Osaka, Japan; Department of Orthopedic Surgery, Miyamoto Orthopedic Hospital, 4-2-63 Kunitomi, Naka-ku, Okayama, Okayama 773-8236, Japan; Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan.
| | - Kota Miyoshi
- Department of Orthopaedic and Spine Surgery, Yokohama Rosai Hospital, 3-2-1-1 Kozukue, Kohoku-ku, Kanagawa 222-0036, Japan
| | - Kensuke Kawabata
- Department of Orthopaedic and Spine Surgery, Yokohama Rosai Hospital, 3-2-1-1 Kozukue, Kohoku-ku, Kanagawa 222-0036, Japan
| | - Takeyuki Tanaka
- Department of Orthopaedic Surgery, Sensory and Motor System Medicine, Surgical Sciences, Graduate School of Medicine, The University of Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Sensory and Motor System Medicine, Surgical Sciences, Graduate School of Medicine, The University of Tokyo, Japan
| | - Akihiro Shiroshita
- Scientific Research Works Peer Support Group (SRWS-PSG), Osaka, Japan; Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, USA
| | - Yuki Kataoka
- Scientific Research Works Peer Support Group (SRWS-PSG), Osaka, Japan; Department of Internal Medicine, Kyoto Min-iren Asukai Hospital, Tanaka Asukai-cho 89, Sakyo-ku, Kyoto 606-8226, Japan; Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University Graduate School of Medicine, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan; Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine/Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
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Nakura N, Hirakawa K, Takayanagi S, Mihara M. Denosumab prevented periprosthetic bone resorption better than risedronate after total hip arthroplasty. J Bone Miner Metab 2023; 41:239-247. [PMID: 36745212 DOI: 10.1007/s00774-023-01405-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/17/2023] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Periprosthetic fracture caused by periprosthetic bone loss is an important concern in total hip arthroplasty (THA). Denosumab has been approved for postmenopausal women with osteoporosis who are at high risk of fracture. In this randomized controlled trial, we compared the effects of denosumab and risedronate on periprosthetic bone mineral density (BMD) after THA. MATERIALS AND METHODS The current study analyzed 108 patients who were scheduled to have THA. For 2 years, the patients were randomly assigned to the following two treatment groups: denosumab (60 mg subcutaneously every 6 months) or risedronate (17.5 mg oral weekly). The BMD changes in all Gruen zones and bone turnover markers were measured at the 5th postoperative day (baseline) and 6, 12, 18, and 24 months postoperatively. RESULTS The mean BMD in zones 1, 2, 6, and 7 was significantly higher with denosumab all administration at all postoperative time points compared to the risedronate group. The mean percentage changes in the BMD in these zones from baseline to 24 months postoperatively were + 11.9, + 2.9, + 8.1, and + 5.9% with denosumab group and - 9.6% -3.6, - 2.3, and - 19.2% with risedronate, respectively. The osteoclastic marker, tartrate-resistant acid phosphatase-5b (TRACP-5b), was significantly lower in the denosumab group compared to the risedronate group by 2 months. CONCLUSION Denosumab is more effective in preventing periprosthetic bone resorption than risedronate in the proximal femur. It also increased BMD around the stem implant following THA.
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Affiliation(s)
- Nariaki Nakura
- Shonan Kamakura Joint Reconstruction Center, 5-4-17 Dai, Kamakura, Kanagawa, 247-0061, Japan.
- Kitakyushu General Hospital, Fukuoka, Japan.
| | - Kazuo Hirakawa
- Shonan Kamakura Joint Reconstruction Center, 5-4-17 Dai, Kamakura, Kanagawa, 247-0061, Japan
| | - Satoshi Takayanagi
- Shonan Kamakura Joint Reconstruction Center, 5-4-17 Dai, Kamakura, Kanagawa, 247-0061, Japan
| | - Masahiko Mihara
- Shonan Kamakura Joint Reconstruction Center, 5-4-17 Dai, Kamakura, Kanagawa, 247-0061, Japan
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Li X, Han J, Shi X, Bi Z, Liu J. Zoledronic acid and denosumab for periprosthetic bone mineral density loss after joint arthroplasty: a systematic review and meta-analysis of randomized controlled trials. Arch Osteoporos 2023; 18:37. [PMID: 36840811 DOI: 10.1007/s11657-023-01227-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/10/2023] [Indexed: 02/26/2023]
Abstract
OBJECTIVE Periprosthetic bone mineral density (BMD) loss after total hip arthroplasty (THA) may threaten the survival of implants. Zoledronic acid (ZA) and denosumab were effective in reducing bone loss in conditions associated with accelerated bone turnover by inhibiting osteoclast activity. This meta-analysis aimed to assess the efficiency and safety of ZA and denosumab for periprosthetic BMD loss after THA. METHODS A systematic search of randomized controlled trials (RCTs) associated with ZA or denosumab and THA was performed in MEDLINE, PubMed, Embase, the Cochrane Central Register of Controlled Trials, and the Web of Science from 1980 to 2022. Meta-analysis was performed by the Cochrane Review Manager 5 (RevMan) version 5.41. Cochrane risk of bias tool and GRADEpro were applied for methodological quality and overall evidence quality, respectively. RESULTS Nine RCTs involving a total of 480 patients were finally included and analyzed. The pooled data that demonstrated significantly less periprosthetic BMD loss in Gruen zone 7 occurred in the intervention group patients than in the control group patients at 3 months (MD = 4.30, 95% CI: 1.78-6.82, P = 0.0008), 6 months (MD = 7.71, 95% CI: 5.41-10.02, P < 0.00001), and 12 months (MD = 8.19, 95% CI: 5.97-10.42, P < 0.00001) after THA. No serious adverse events (AEs) were observed. CONCLUSION In the current analysis with evidence on the efficacy and safety of ZA and denosumab, the authors recommend the use of ZA or denosumab treatment for periprosthetic bone mineral density loss. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number: CRD42022369273.
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Affiliation(s)
- Xiao Li
- Department of Orthopedics, First Hospital of Jilin University, Changchun, Jilin, China
| | - Jingru Han
- Department of Oncology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaotong Shi
- Department of Orthopedics, First Hospital of Jilin University, Changchun, Jilin, China
| | - Zhiguo Bi
- Department of Orthopedics, First Hospital of Jilin University, Changchun, Jilin, China
| | - Jianguo Liu
- Department of Orthopedics, First Hospital of Jilin University, Changchun, Jilin, China.
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Bottai V, Piolanti N, Digrandi G, Menconi A, Antognetti D, Di Lonardo M, Scaglione M, Raffaetà G. Impending atypical femoral fractures associated with bisphosphonates: postoperative diagnosis after hip prosthesis. Clinical cases presentation. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022257. [PMID: 36129726 PMCID: PMC10510971 DOI: 10.23750/abm.v93is1.13084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/12/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM Number of hip prosthesis implants in arthritis, number of patients treated with bisphosphonates to prevent fragility fractures and, together, number of atypical femoral fracture's cases are increasing. CASE SERIES This article describes two cases of hip arthritis, treated with hip replacement, in patients using bisphosphonates for a long time; in both cases an incomplete atypical femoral fracture was misdiagnosed before the surgery. Authors describe the importance to carry out a complete osteometabolic and radiographic pre-operative examination of patients in treatment with bisphosphonates going to hip replacement, to check the possible presence of incomplete atypical femoral fracture and to optimize surgical and pharmacological treatment. CONCLUSIONS In hip prosthesis surgery, prior diagnosis of incomplete atypical femoral fractures can indicate the choice of a different kind of prosthesis stem to optimize surgical results. This can also positively impact to rehabilitation in term of duration and daily activities recovery.
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Affiliation(s)
- Vanna Bottai
- Second Orthopedic and Traumatologic Clinic, University of Pisa, Pisa, Toscana, IT.
| | - Nicola Piolanti
- First Orthopedic and Traumatologic Clinic, University of Pisa, Pisa, Toscana, IT.
| | - Giuseppe Digrandi
- First Orthopedic and Traumatologic Clinic, University of Pisa, Pisa, Toscana, IT.
| | - Agnese Menconi
- Orthopedic Rehabilitation Department Section, University of Pisa, Pisa, Toscana, IT.
| | - Damiano Antognetti
- Orthopedic Rehabilitation Department Section, University of Pisa, Pisa, Toscana, IT.
| | - Michele Di Lonardo
- Second Orthopedic and Traumatologic Clinic University of Pisa, Pisa, Toscana, IT.
| | | | - Gloria Raffaetà
- Orthopedic Rehabilitation Department Section, University of Pisa, Pisa, Toscana, IT.
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Hsu AHS, Yen CH, Kuo FC, Wu CT, Huang TW, Cheng JT, Lee MS. Zoledronic Acid Ameliorates the Bone Turnover Activity and Periprosthetic Bone Preservation in Cementless Total Hip Arthroplasty. Pharmaceuticals (Basel) 2022; 15:ph15040420. [PMID: 35455417 PMCID: PMC9030653 DOI: 10.3390/ph15040420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/22/2022] [Accepted: 03/28/2022] [Indexed: 02/04/2023] Open
Abstract
The administration of zoledronic acid (ZA) to patients who received cementless total hip arthroplasty (THA) has been reported to reduce bone turnover markers (BTMs) and increase bone mineral density (BMD). The effects of two-dose ZA versus placebo on cementless THA patients were analyzed in this five-year extension study. Alkaline phosphatase (ALP), osteocalcin (OC), procollagen 1 intact N-terminal propeptide (P1NP), serum calcium, renal function, radiological findings, and functional outcomes were compared in 49 patients, and the periprosthetic BMD of seven Gruen zones were compared in 19 patients. All the patients had normal renal function and calcium levels at their final follow-up. The mean ALP level in the ZA group was significantly lower at the fifth year, mean OC levels were significantly lower at the second and fifth year, and mean P1NP levels were significantly lower from 6 weeks to 5 years as compared with the control group. Fifth-year BMD levels were not found to be different between the ZA and control groups. The BMD Change Ratios in the ZA group were significantly increased in Gruen zone 6 at 1, 2, and 5 years. Our study results suggest that short-term ZA treatment with a subsequent 4-year drug holiday may inhibit serum BTMs and provide periprosthetic bone preservation at five years without adverse events.
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Affiliation(s)
- Allen Herng Shouh Hsu
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung City 833, Taiwan; (A.H.S.H.); (F.-C.K.); (C.-T.W.)
| | - Chun-Hsien Yen
- Ministry of Health and Welfare Cishan Hospital, Kaohsiung City 842, Taiwan;
| | - Feng-Chih Kuo
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung City 833, Taiwan; (A.H.S.H.); (F.-C.K.); (C.-T.W.)
| | - Cheng-Ta Wu
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung City 833, Taiwan; (A.H.S.H.); (F.-C.K.); (C.-T.W.)
| | - Tsan-Wen Huang
- Department of Orthopedic Surgery, Chia-Yi Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Chiayi City 621, Taiwan;
| | - Juei-Tang Cheng
- Department of Medical Research, Chi-Mei Hospital, Tainan City 710, Taiwan
- Correspondence: (J.-T.C.); (M.S.L.); Tel.: +886-6-2517864 (J.-T.C.); +886-7-7317123 (M.S.L.)
| | - Mel S. Lee
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung City 833, Taiwan; (A.H.S.H.); (F.-C.K.); (C.-T.W.)
- Correspondence: (J.-T.C.); (M.S.L.); Tel.: +886-6-2517864 (J.-T.C.); +886-7-7317123 (M.S.L.)
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Mohanty SS, Vasavda AN, Rai AK, Rathod TN, Kamble P, Keny S. Short-Term Analysis of the Changes in the Bone Mineral Density of the Proximal Femur After Uncemented Total Hip Arthroplasty: A Prospective Study of 110 Patients. Cureus 2022; 14:e23257. [PMID: 35449673 PMCID: PMC9013210 DOI: 10.7759/cureus.23257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2022] [Indexed: 11/12/2022] Open
Abstract
Introduction Mechanical loading continuously exposes the bone to remodeling processes. Increased load leads to a gain in bone mass, and reduced load results in a loss. After inserting a prosthesis, the proximal femur is bypassed in loading as the bodyweight shifts distally. This lack of load induces bone resorption according to Wolff’s law. To avoid this bone resorption, the implant's bending stiffness should be less than the femoral bone. Dual-energy X-ray absorptiometry (DEXA) is a well-accepted method to measure periprosthetic bone mineral density (BMD) after total hip arthroplasty (THA). Since the strength and durability of the fixation of a femoral prosthesis in cementless hip arthroplasty depend largely on the quantity and quality of the surrounding bone, preoperative and postoperative evaluation of the quantity and quality of the femoral bone is very important in the long-term prognosis of hip arthroplasty. Materials and methods A prospective study of 110 patients in the age group of 25-60 years who underwent uncemented total hip arthroplasty in our tertiary healthcare institution was performed. An uncemented, fully hydroxyapatite-coated implant from a single manufacturer was used in all the patients. All the patients were mobilized on the first post-operative day. The BMD was measured at the proximal femur and the distal tip using a DEXA scan. Gruen zones were used for calculating BMD at different anatomical locations in the femur, with particular importance to zones 1, 4, and 7. Results The pre-operative BMD in all zones measured, viz. zones 1, 4, and zone 7 of the affected side, was found to be significantly lower as compared to the BMD values on the control side (P< 0.05). The mean change in the mean BMD was calculated for all the zones and compared with each other using an unpaired t-test. The mean BMD changes were found to be significantly higher in zone 7 in comparison to both zones 1 and 4 (p<0.05). Conclusion Significant periprosthetic bone loss after uncemented THA in the femur was noted in Gruen zones 1, 4, and 7 during the first six months after THA, with the greatest bone loss in the femoral calcar area (zone 7). The lower the preoperative BMD of the patient, the greater the postoperative bone loss.
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Liu Y, Xu JW, Li MY, Wu LM, Zeng Y, Shen B. Zoledronic Acid for Periprosthetic Bone Mineral Density Changes in Patients With Osteoporosis After Hip Arthroplasty-An Updated Meta-Analysis of Six Randomized Controlled Trials. Front Med (Lausanne) 2022. [PMID: 35004777 DOI: 10.3389/fmed.2021.80128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Abstract
Introduction: Periprosthetic bone mineral density (BMD) loss following total hip arthroplasty (THA) may threaten the survival of the implant, especially in patients with osteoporosis. Zoledronic acid (ZA) is the representative of the third generation of bisphosphonates, which were effective in reducing bone loss in conditions associated with accelerated bone turnover. The aim of this study was to evaluate the efficacy and safety of ZA in patients with osteoporosis after THA. Methods: Randomized controlled trials (RCTs) associated with ZA and THA were searched from the MEDLINE, PubMed, EMBASE, Wanfang database, and the Web of Science (August 2021). Other methods, such as hand search and email request were also tried. The methodological quality was assessed by the Risk of Bias (RoB) 2.0. Relevant data were abstracted from the included RCTs and authors were contacted when necessary. Results: In this study, six RCTs involving a total of 307 patients were finally included and analyzed. The pooled data demonstrated that significantly less periprosthetic BMD loss in Gruen zone seven had occurred in the ZA-treated patients than in the control patients at 3 months (mean difference [MD] = 4.03%; 95% CI: 0.29-7.76%; P = 0.03), 6 months (MD = 7.04%; 95% CI: 2.12-11.96%; P = 0.005), and 12 months (MD = 7.12%; 95% CI: 0.33-13.92%; P = 0.04). The Harris Hip Score (HHS) was also significantly increased in ZA group at 6 and 12 months after operation (P = 0.03 and P = 0.02, respectively). Influenza-like symptom was found related to the usage of ZA [relative risk (RR) = 7.03, P < 0.0001]. Conclusion: A meta-analysis of six RCTs suggested that ZA was beneficial in maintaining the periprosthetic BMD in patients with osteoporosis at 6 and 12 months after THA. In addition, the HHS was significantly improved in patients treated with ZA. However, the short length of follow-up of the available studies resulted in the lack of analyses regarding the survival of implants including the rate of aseptic loosing, periprosthetic fracture, and revision. It still needs to be determined in research with longer follow-up period. Clinical Trial Registration: Researchregistry.com, identifier: reviewregistry1087.
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Affiliation(s)
- Yuan Liu
- Department of Orthopedics, National Clinical Research Center for Geriatrics, Orthopedics Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Jia-Wen Xu
- Department of Orthopedics, National Clinical Research Center for Geriatrics, Orthopedics Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Ming-Yang Li
- Department of Orthopedics, National Clinical Research Center for Geriatrics, Orthopedics Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Li-Min Wu
- Department of Orthopedics, National Clinical Research Center for Geriatrics, Orthopedics Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Zeng
- Department of Orthopedics, National Clinical Research Center for Geriatrics, Orthopedics Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Bin Shen
- Department of Orthopedics, National Clinical Research Center for Geriatrics, Orthopedics Research Institute, West China Hospital, Sichuan University, Chengdu, China
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Liu Y, Xu JW, Li MY, Wu LM, Zeng Y, Shen B. Zoledronic Acid for Periprosthetic Bone Mineral Density Changes in Patients With Osteoporosis After Hip Arthroplasty-An Updated Meta-Analysis of Six Randomized Controlled Trials. Front Med (Lausanne) 2021; 8:801282. [PMID: 35004777 PMCID: PMC8733298 DOI: 10.3389/fmed.2021.801282] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 11/23/2021] [Indexed: 02/05/2023] Open
Abstract
Introduction: Periprosthetic bone mineral density (BMD) loss following total hip arthroplasty (THA) may threaten the survival of the implant, especially in patients with osteoporosis. Zoledronic acid (ZA) is the representative of the third generation of bisphosphonates, which were effective in reducing bone loss in conditions associated with accelerated bone turnover. The aim of this study was to evaluate the efficacy and safety of ZA in patients with osteoporosis after THA. Methods: Randomized controlled trials (RCTs) associated with ZA and THA were searched from the MEDLINE, PubMed, EMBASE, Wanfang database, and the Web of Science (August 2021). Other methods, such as hand search and email request were also tried. The methodological quality was assessed by the Risk of Bias (RoB) 2.0. Relevant data were abstracted from the included RCTs and authors were contacted when necessary. Results: In this study, six RCTs involving a total of 307 patients were finally included and analyzed. The pooled data demonstrated that significantly less periprosthetic BMD loss in Gruen zone seven had occurred in the ZA-treated patients than in the control patients at 3 months (mean difference [MD] = 4.03%; 95% CI: 0.29-7.76%; P = 0.03), 6 months (MD = 7.04%; 95% CI: 2.12-11.96%; P = 0.005), and 12 months (MD = 7.12%; 95% CI: 0.33-13.92%; P = 0.04). The Harris Hip Score (HHS) was also significantly increased in ZA group at 6 and 12 months after operation (P = 0.03 and P = 0.02, respectively). Influenza-like symptom was found related to the usage of ZA [relative risk (RR) = 7.03, P < 0.0001]. Conclusion: A meta-analysis of six RCTs suggested that ZA was beneficial in maintaining the periprosthetic BMD in patients with osteoporosis at 6 and 12 months after THA. In addition, the HHS was significantly improved in patients treated with ZA. However, the short length of follow-up of the available studies resulted in the lack of analyses regarding the survival of implants including the rate of aseptic loosing, periprosthetic fracture, and revision. It still needs to be determined in research with longer follow-up period. Clinical Trial Registration: Researchregistry.com, identifier: reviewregistry1087.
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Affiliation(s)
| | | | | | | | | | - Bin Shen
- Department of Orthopedics, National Clinical Research Center for Geriatrics, Orthopedics Research Institute, West China Hospital, Sichuan University, Chengdu, China
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11
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Lee SW, Kim WY, Song JH, Kim JH, Lee HH. Factors Affecting Periprosthetic Bone Loss after Hip Arthroplasty. Hip Pelvis 2021; 33:53-61. [PMID: 34141691 PMCID: PMC8190495 DOI: 10.5371/hp.2021.33.2.53] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/16/2021] [Accepted: 03/29/2021] [Indexed: 12/22/2022] Open
Abstract
Periprosthetic bone loss may lead to major complications in hip arthroplasty, including aseptic loosening, implant migration, and even periprosthetic fracture. Such a complication leads to revision surgeries, which are expensive, technically demanding, and result in a low satisfaction rate. Therefore, a study was conducted of the factors affecting the periprosthetic bone loss around the stem that caused these complications. Factors influencing periprosthetic bone loss include demographic factors such as age, sex, obesity, smoking, and comorbidity including diabetes and osteoporosis. The implant design and fixation method are also factors that are determined before surgery. In addition, there are surgical factors, such as surgical approach and surgical technique, and we wish to investigate the factors affecting periprosthetic bone loss around the stem by comparing the effects of postoperative rehabilitation protocols and osteoporosis drugs.
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Affiliation(s)
- Se-Won Lee
- Department of Orthopedic Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Weon-Yoo Kim
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Joo-Hyoun Song
- Department of Orthopedic Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Jae-Hoon Kim
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Hwan-Hee Lee
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
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12
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Zhu K, Zhang J, Zhang C, Zhao Z, Gao J, Li X, Xia X, Xu X, Zhang T, Guan J. Therapeutic efficacy of zoledronic acid combined with calcitriol in elderly patients receiving total hip arthroplasty or hemiarthroplasty for osteoporotic femoral neck fracture. Osteoporos Int 2021; 32:559-564. [PMID: 32989470 DOI: 10.1007/s00198-020-05637-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 09/10/2020] [Indexed: 11/29/2022]
Abstract
UNLABELLED Zoledronic acid could improve the clinical outcome in elderly patients receiving total hip arthroplasty or hemiarthroplasty for osteoporotic femoral neck fracture in the 1-year prospective study. INTRODUCTION To validate the therapeutic efficacy of zoledronic acid (ZOL) in elderly patients with femoral neck fracture who received total hip arthroplasty (THA) or hemiarthroplasty (HA). METHODS Included in this study were 95 elderly patients with femoral neck fractures who received THA/HA between August 2015 and June 2018. They were randomized into a ZOL group and a control group. Patients in ZOL group received a yearly single dose of 5 mg ZOL intravenous injection plus 0.5 μg/day calcitriol and 1000 mg/day calcium carbonate 2 days before THA or HA. Patients in the control group were treated with the same dose of calcitriol and calcium carbonate only without ZOL. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry. Bone metabolism markers including the total extension of the peptide type I collagen amino end (P1NP) and beta collagen degradation product (β-CTX) were obtained by serum examination. The postoperative functional outcome was assessed using Harris Hip Score (HHS). RESULTS During the follow-up period, BMD in the ZOL group was improved and significantly higher than that in the control group at 6 and 12 months post-operation. Bone metabolism markers P1NP and β-CTX in ZOL group remained at a relatively low level as compared with that in the control group at 6 months after treatment. No significant difference in the mean HHS and the excellent/good rate of joint function was observed during the follow-up period between the two groups. The occurrence of adverse events in the ZOL group was significantly higher than that in the control group. CONCLUSIONS A single infusion of ZOL shows promise in improving BMD of the healthy side of the femoral neck, lumbar spine, and total hip and decreasing the level of bone markers, which may improve the clinical outcome of patients with osteoporotic femoral neck fractures receiving THA/HA.
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Affiliation(s)
- K Zhu
- Jinan University, Guangzhou, China
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - J Zhang
- Department of Rheumatology, Changhai Hospital, Shanghai, China
| | - C Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Z Zhao
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - J Gao
- Department of Rheumatology, Changhai Hospital, Shanghai, China
| | - X Li
- Department of Rheumatology, Changhai Hospital, Shanghai, China
| | - X Xia
- Department of Rheumatology, Changhai Hospital, Shanghai, China
| | - X Xu
- Department of Rheumatology, Changhai Hospital, Shanghai, China.
| | - T Zhang
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.
| | - J Guan
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China.
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13
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Slullitel PA, Mahatma MM, Farzi M, Grammatopoulos G, Wilkinson JM, Beaulé PE. Influence of Femoral Component Design on Proximal Femoral Bone Mass After Total Hip Replacement: A Randomized Controlled Trial. J Bone Joint Surg Am 2021; 103:74-83. [PMID: 33079901 DOI: 10.2106/jbjs.20.00351] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND In this randomized controlled trial (RCT), we compared bone remodeling and bone turnover between 2 total hip arthroplasty implants-the short, proximally porous-coated Tri-Lock Bone-Preservation Stem and a conventional, fully-coated Corail prosthesis-over a 2-year postoperative period. METHODS Forty-six participants received the Tri-Lock prosthesis and 40 received the Corail prosthesis. At baseline, the 2 groups had similar demographics, proximal femoral bone mineral density (BMD), bone turnover markers, radiographic canal flare index, and patient-reported outcome measure (PROM) scores. Outcomes were measured at weeks 26, 52, and 104. RESULTS Loss of periprosthetic bone, measured by high-sensitivity dual x-ray absorptiometry region-free analysis (DXA-RFA), was identified at the calcar and proximal-lateral aspect of the femur in both prosthesis groups (p < 0.05). However, the conventional prosthesis was associated with a smaller reduction in BMD compared with the bone-preservation prosthesis (p < 0.001). This effect was most prominent in the region of the femoral calcar and greater trochanter. A small gain in BMD was also identified in some areas, and this gain was greater with the conventional than the bone-preservation prosthesis (p < 0.001). The 2 groups had similar changes in bone turnover markers and improvement in PROM scores over the study period (p > 0.05). The adverse-event rate was also similar between the groups (p > 0.05). CONCLUSIONS This RCT shows that prostheses intended to preserve proximal femoral bone do not necessarily perform better in this regard than conventional cementless designs. DXA-RFA is a sensitive tool for detecting spatially complex patterns of periprosthetic bone remodeling. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Pablo A Slullitel
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.,Institute of Orthopaedics 'Carlos E. Ottolenghi', Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Mohit M Mahatma
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - Mohsen Farzi
- Centre for Computational Imaging and Simulation Technologies in Bioscience, University of Leeds, Leeds, United Kingdom
| | | | - J Mark Wilkinson
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
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14
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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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15
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Fu G, Li M, Xue Y, Li Q, Deng Z, Ma Y, Zheng Q. Perioperative patient-specific factors-based nomograms predict short-term periprosthetic bone loss after total hip arthroplasty. J Orthop Surg Res 2020; 15:503. [PMID: 33138840 PMCID: PMC7607681 DOI: 10.1186/s13018-020-02034-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 10/20/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Although medical intervention of periprosthetic bone loss in the immediate postoperative period was recommended, not all the patients experienced periprosthetic bone loss after total hip arthroplasty (THA). Prediction tools that enrolled all potential risk factors to calculate an individualized prediction of postoperative periprosthetic bone loss were strongly needed for clinical decision-making. METHODS Data of the patients who underwent primary unilateral cementless THA between April 2015 and October 2017 in our center were retrospectively collected. Candidate variables included demographic data and bone mineral density (BMD) in spine, hip, and periprosthetic regions that measured 1 week after THA. Outcomes of interest included the risk of postoperative periprosthetic bone loss in Gruen zone 1, 7, and total zones in the 1st postoperative year. Nomograms were presented based on multiple logistic regressions via R language. One thousand Bootstraps were used for internal validation. RESULTS Five hundred sixty-three patients met the inclusion criteria were enrolled, and the final analysis was performed in 427 patients (195 male and 232 female) after the exclusion. The mean BMD of Gruen zone 1, 7, and total were decreased by 4.1%, 6.4%, and 1.7% at the 1st year after THA, respectively. 61.1% of the patients (261/427) experienced bone loss in Gruen zone 1 at the 1st postoperative year, while there were 58.1% (248/427) in Gruen zone 7 and 63.0% (269/427) in Gruen zone total. Bias-corrected C-index for risk of postoperative bone loss in Gruen zone 1, 7, and total zones in the 1st postoperative year were 0.700, 0.785, and 0.696, respectively. The most highly influential factors for the postoperative periprosthetic bone loss were primary diagnosis and BMD in the corresponding Gruen zones at the baseline. CONCLUSIONS To the best of our knowledge, our study represented the first time to use the nomograms in estimating the risk of postoperative periprosthetic bone loss with adequate predictive discrimination and calibration. Those predictive models would help surgeons to identify high-risk patients who may benefit from anti-bone-resorptive treatment in the early postoperative period effectively. It is also beneficial for patients, as they can choose the treatment options based on a reasonable expectation following surgery.
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Affiliation(s)
- Guangtao Fu
- Division of Orthopedics, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province People’s Republic of China
| | - Mengyuan Li
- Division of Orthopedics, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province People’s Republic of China
| | - Yunlian Xue
- Division of Statistics, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province People’s Republic of China
| | - Qingtian Li
- Division of Orthopedics, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province People’s Republic of China
| | - Zhantao Deng
- Division of Orthopedics, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province People’s Republic of China
| | - Yuanchen Ma
- Division of Orthopedics, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province People’s Republic of China
| | - Qiujian Zheng
- Division of Orthopedics, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province People’s Republic of China
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16
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Gong L, Zhang YY, Yang N, Qian HJ, Zhang LK, Tan MS. Raloxifene Prevents Early Periprosthetic Bone Loss for Postmenopausal Women after Uncemented Total Hip Arthroplasty: A Randomized Placebo-Controlled Clinical Trial. Orthop Surg 2020; 12:1074-1083. [PMID: 32686337 PMCID: PMC7454213 DOI: 10.1111/os.12696] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To examine the results of raloxifene for prevention of periprosthetic bone loss around the femoral stem in patients undergoing total hip arthroplasty (THA). METHODS Between January 2015 and May 2017, 240 female patients between 55 and 80 years underwent primary THA and were randomly allocated to receive 60 mg raloxifene hydrochloride per day (treatment group, TG, n = 120) or placebo (control group, CG, n = 120) orally at bedtime using computer-generated randomization sequence generation. Baseline data, the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC), women's quality of life (QoL) score, bone mineral density (BMD) around the prosthesis, and adverse events were compared between the two groups. The measuring range of BMD around the prosthesis was divided into seven regions of interest (ROI). The sample size was calculated to detect a mean difference in BMD of 0.15 g/cm2 with a standard deviation (SD) of 0.3. The error was set at 0.05 and the power level at 90% with additional compensation for a possible dropout rate of 20%. RESULTS A total of 240 participants in the study up to 24 months after THA. There were no significant differences in the mean BMD of all the zones between groups before surgery (all P > 0.05). However, there were significant differences in the BMD of Gruen zones 4 and 7 between groups at 6 months postoperatively (both P < 0.05); there were significant differences in Gruen zones 1, 4, 6, and 7 at 12 months postoperatively (all P < 0.01); there were significant differences in Gruen zones 1, 2, 4, 6, and 7 at 24 months postoperatively (all P < 0.001). Patients taking raloxifene reported higher QoL scores, with better improvement in BMD in all areas except in zones 3 and 5 compared with the control group. There were no significant differences in WOMAC pain (P = 0.4045), WOMAC function (P = 0.4456) and women's QoL scores (P = 0.5983) between groups before surgery. However, WOMAC pain, WOMAC function and women's QoL score in the treatment group were significantly better at all time points (all P < 0.05). Patients in the treatment group showed no increased adverse events, including cardiac events, stroke, venous thromboembolism, and gynecological cancer (all P > 0.05), but did show decreased odds of breast cancer in comparison with those using a placebo (P = 0.0437). CONCLUSION Raloxifene can help inhibit bone loss around the prosthesis and improve the QoL of postmenopausal women after THA with no increased adverse events, and can even decrease the odds of breast cancer.
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Affiliation(s)
- Long Gong
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Peking Union Medical College, Chinese Academy of Medical College, Beijing, China
| | - Yao-Yao Zhang
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, Chengdu, China
| | - Na Yang
- Bao Ding Maternal and Children Hospital, Baoding, China
| | - Huan-Juan Qian
- Department of Orthopedics Surgery, 81 Group Military Hospital of Chinese PLA, Baoding, China
| | - Ling-Kun Zhang
- Department of Orthopedics Surgery, 81 Group Military Hospital of Chinese PLA, Baoding, China
| | - Ming-Sheng Tan
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Peking Union Medical College, Chinese Academy of Medical College, Beijing, China
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17
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Abstract
There is a high prevalence of osteoporosis in patients undergoing total hip arthroplasty. There are several clinically relevant questions related to the management of such cases: the effect of ageing; the initial osseointegration of implants, especially when cementless THA is used; the effect of medical osteoporosis treatment on bone-implant interface; the incidence of intraoperative and late periprosthetic fractures, and the long-term survival of both cemented and cementless total hip arthroplasty performed for proximal femoral fractures and hip osteoarthritis. A critical review of the literature is presented in an attempt to draw practical conclusions.
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Affiliation(s)
- Theofilos S Karachalios
- Orthopaedic Department, University General Hospital of Larissa, Larissa, Hellenic Republic (Greece).,School of Health Sciences, Faculty of Medicine, University of Thessalia, Biopolis Mezourlo Region, Larissa, Hellenic Republic (Greece)
| | - Antonios A Koutalos
- Orthopaedic Department, University General Hospital of Larissa, Larissa, Hellenic Republic (Greece)
| | - George A Komnos
- Orthopaedic Department, University General Hospital of Larissa, Larissa, Hellenic Republic (Greece)
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18
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Shao L, Wu XD. The Efficacy of Denosumab for Prevention of Early Periprosthetic Bone Loss After Cementless Total Hip Arthroplasty. J Bone Miner Res 2020; 35:998-999. [PMID: 32163620 DOI: 10.1002/jbmr.3983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/16/2020] [Accepted: 01/29/2020] [Indexed: 01/20/2023]
Affiliation(s)
- Long Shao
- Department of Orthopaedic Surgery, Ningbo No. 6 Hospital, Ningbo, China
| | - Xiang-Dong Wu
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Mittelstaedt H, Hochreiter J, Anderl C, Johl C, Krüger T, Hubel W, Weigert U, Schagemann JC. Calcar-Guided Short Stems in Total Hip Arthroplasty: A Two-Year Prospective Multicentre Study. Open Orthop J 2020. [DOI: 10.2174/1874325002014010033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
Background:
Calcar-guided short-stem Total Hip Arthroplasty (THA) is increasingly being used to preserve proximal femoral bone stock for potential later revision surgery.
Objective:
In this study, we aimed to expand the clinical evidence on calcar-guided short-stem THA used in daily clinical practice, focusing on clinical outcomes as well as radiographic signs of stress shielding and femoral bone loss.
Methods:
In a prospective multicentre study, we enrolled 213 patients with a total of 224 THAs for mainly degenerative indications. The patients were examined clinically and radiographically 6 to 12 weeks, 12 months, and 24 months postoperatively.
Results:
All clinical outcomes improved significantly over the first 6 to 12 weeks compared to preoperative values (P < 0.001). At 24 months, the mean Harris hip score was 95.3 ± 6.7, and the mean visual analogue scale for pain was 1.0 ± 1.7 under load and 0.5 ± 1.3 at rest. We observed early distal stem migration in six patients and late migration in one patient. Additionally, we found 16 cases of radiographic signs indicative of stress shielding. Four patients required stem revision surgery: two for stem migration, one for periprosthetic fracture, and one for deep infection.
Conclusion:
Overall, calcar-guided short-stem THA resulted in excellent clinical outcomes after two years of follow-up, and the radiographs revealed few signs of stress shielding. We, therefore, regard calcar-guided short-stem THA as a safe and effective treatment alternative in daily clinical practice.
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20
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Fu GT, Lin LJ, Sheng PY, Li CC, Zhang JX, Shen J, Liu S, Xue YL, Lin SP, Wang K, Zheng QJ, Ding Y. Efficiency of Zoledronic Acid in Inhibiting Accelerated Periprosthetic Bone Loss After Cementless Total Hip Arthroplasty in Osteoporotic Patients: A Prospective, Cohort Study. Orthop Surg 2020; 11:653-663. [PMID: 31456320 PMCID: PMC6712387 DOI: 10.1111/os.12513] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 07/09/2019] [Accepted: 07/10/2019] [Indexed: 11/30/2022] Open
Abstract
Objective To investigate the influence of preoperative osteopenia/osteoporosis on periprosthetic bone loss after total hip arthroplasty (THA) and the efficiency of zoledronate (ZOL) treatment in periprosthetic bone preservation. Methods This multicenter, prospective cohort study was conducted in four centers between April 2015 and October 2017. Patients were assigned to Normal BMD, Osteopenia, and Osteoporosis+ZOL groups. Patients with osteopenia received daily oral calcium (600 mg/d) and vitamin D (0.5 μg/d), while patients in the Osteoporosis+ZOL group received additional ZOL annually (5 mg/year). Periprosthetic bone mineral density (BMD) in seven Gruen zones, radiographic parameters, Harris hip score, EuroQol 5‐Dimensions (EQ‐5D) score, and BMD in hip and spine were measured within 7 days, 3 months, 12 months postoperation and annually thereafter. Results A total of 266 patients were enrolled, while 81 patients that completed the first year follow‐up were involved in the statistical analysis. The mean follow‐up time was 1.3 years. There were significant decreases of mean BMD in total Gruen zones (−4.55%, P < 0.05) and Gruen zone 1 (−10.22%, P < 0.01) in patients with osteopenia during the first postoperative year. Patients in the Osteoporosis+ZOL group experienced a marked increase in BMD in Gruen zone 1 (+16%) at the first postoperative year, which had a significant difference when compared with the Normal BMD group (P < 0.05) and the Osteopenia Group (P < 0.001). Low preoperative BMD in hip and spine was predictive of bone loss in Gruen zone 1 at 12 months after THA in patients with normal BMD (R2 = 0.40, P < 0.05). Conclusions Patients with osteopenia are prone to higher bone loss in the proximal femur after cementless total hip arthroplasty (THA). ZOL, not solely calcium and vitamin D, could prevent the accelerated periprosthetic bone loss after THA in patients with osteopenia and osteoporosis.
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Affiliation(s)
- Guang-Tao Fu
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China.,Division of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China
| | - Li-Jun Lin
- Department of Orthopaedics, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong Province, China
| | - Pu-Yi Sheng
- Department of Orthopaedics, the First affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Chang-Chuan Li
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Jin-Xin Zhang
- Public Health College, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Jun Shen
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Sheng Liu
- Department of Nuclear Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yun-Lian Xue
- Division of Statistics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China
| | - Si-Peng Lin
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Kun Wang
- Department of Orthopaedics, The Third affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Qiu-Jian Zheng
- Division of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China
| | - Yue Ding
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
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Battaglino RA, Nguyen N, Summers M, Morse LR. Factors associated with osteocalcin in men with spinal cord injury: findings from the FRASCI study. Spinal Cord 2019; 57:1014-1022. [DOI: 10.1038/s41393-019-0327-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 06/15/2019] [Accepted: 06/19/2019] [Indexed: 11/09/2022]
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22
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Abstract
Arthroplasty has become a very successful operation with excellent long-term results. A dedicated diagnostic set-up to exclude osteoporosis prior to a joint replacement and the use of drugs to improve the outcome of a joint replacement are currently not recommended. Knee arthroplasty should always be cemented in patients with known osteoporosis. The same is recommended for hip joint replacement, even if the cement-free acetabular component yields good results. Rapid loading and mobilization appear beneficial also with respect to the osteoporosis and its systemic treatment.
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Affiliation(s)
- Carl Haasper
- Orthopädie, Unfallchirurgie und Ästhetik, AMEOS Klinikum Seepark, Langener Str. 66, 27607, Geestland, Deutschland.
| | - Mustafa Citak
- HELIOS ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Deutschland
| | - Max Ettinger
- Orthopädische Klinik, Annastift Hannover, Medizinische Hochschule Hannover, Anna-von-Börries-Str. 1-7, 30625, Hannover, Deutschland
| | - Thorsten Gehrke
- HELIOS ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Deutschland
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23
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Results of Conversion from Failed Austin-Moore Hemiarthroplasty to Cementless Total Hip Arthroplasty in Octogenarian Patients with Advanced Acetabular Erosion: A Minimum of 5 Years of Follow-Up. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7814602. [PMID: 31061827 PMCID: PMC6466933 DOI: 10.1155/2019/7814602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 03/17/2019] [Indexed: 11/17/2022]
Abstract
Austin-Moore hemiarthroplasty (HA) had been selectively used for elderly patients with femoral neck fractures. With increasing life span and activity, the sequela of Austin-Moore HA make the implant no longer favorable. The treatment of failed Austin-Moore HA with advanced acetabular erosion is challenging; however, little has been published regarding this topic. The aim of this study was to evaluate the mid-term results of using cementless total hip arthroplasty (THA) in octogenarians. Between 2008 and 2011, 47 patients (32 women and 15 men) with an average age of 86 years (range 83-89 years) were enrolled in this retrospective study. After an average follow-up period of 6.2 years (range 5.0-7.8 years), no migration or loosening of the cup or femoral stem was found. Harris hip scores improved from 36 (range 15-42) preoperatively to 87 (range 80-90). There were no complications directly associated with the procedure except for superficial infections in two patients. Our results suggest that using cementless THA can result in favorable radiographic and clinical outcomes in octogenarian patients.
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24
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Huang KC, Huang TW, Chuang PY, Yang TY, Chang SF. Zoledronate induces cell cycle arrest and differentiation by upregulating p21 in mouse MC3T3-E1 preosteoblasts. Int J Med Sci 2019; 16:751-756. [PMID: 31217743 PMCID: PMC6566742 DOI: 10.7150/ijms.32612] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 03/23/2019] [Indexed: 12/24/2022] Open
Abstract
Background: Increasing research has recently been focused on the supplementary use of drugs such as bisphosphonates that are known to influence bone turnover to prevent and treat periprosthetic bone loss and subsequent implant loosening following total joint replacements. However, there are still concerns about the conflicting effects of bisphosphonate treatment on osteoblastic bone formation in the literature. Methods: In this study, we investigate the role of zoledronate (ZOL) in regulating cell cycle distribution and differentiation in mouse MC3T3-E1 preosteoblasts and also explore the mechanism underlying this effect of ZOL. We examined the expression levels of osteocalcin (OCN) by quantitative polymerase chain reaction (qPCR), the total amount of CDK6, p21 and p27 proteins by Western blot analysis, and the cell cycle distribution by flow cytometric analysis in mouse MC3T3-E1 preosteoblasts to evaluate the effect of ZOL. Small interfering RNAs (siRNAs) were used to assess the individual contributions of genes to specific osteoblast phenotypes. Results: In addition to increased OCN expression, we found that ZOL treatment induces the G0/G1 arrest and results in the increase of p21 and p27 expressions and decrease of CDK6 expression in mouse MC3T3-E1 preosteoblasts. Both p21 and p27 mediates ZOL-induced cell cycle exit; however, p21, but not p27, is responsible for the increase of ZOL-induced OCN expression in these cells. Conclusions: These results endorse that ZOL might have an anabolic effect on osteoblasts. The CDK inhibitor p21 plays a key role in regulating osteoblast differentiation by controlling proliferation-related events in mouse MC3T3-E1 preosteoblasts.
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Affiliation(s)
- Kuo-Chin Huang
- Department of Orthopaedic Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi County 61363, Taiwan.,Chang Gung University College of Medicine, Taoyuan City 33302, Taiwan
| | - Tsan-Wen Huang
- Department of Orthopaedic Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi County 61363, Taiwan
| | - Po-Yao Chuang
- Department of Orthopaedic Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi County 61363, Taiwan
| | - Tien-Yu Yang
- Department of Orthopaedic Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi County 61363, Taiwan
| | - Shun-Fu Chang
- Department of Medical Research and Development, Chiayi Chang Gung Memorial Hospital, Chiayi County 61363, Taiwan
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25
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Shi M, Chen L, Xin Z, Wang Y, Wang W, Yan S. Bisphosphonates for the preservation of periprosthetic bone mineral density after total joint arthroplasty: a meta-analysis of 25 randomized controlled trials. Osteoporos Int 2018; 29:1525-1537. [PMID: 29654342 DOI: 10.1007/s00198-018-4488-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 03/12/2018] [Indexed: 11/26/2022]
Abstract
UNLABELLED The present meta-analysis aimed to evaluate the long-term efficacy of bisphosphonates (BPs) on preservation of periprosthetic bone mineral density (BMD) after joint arthroplasty. It confirmed the protective effect of BPs in a long-term follow-up, and found the influence factors on this effect. INTRODUCTION Periprosthetic bone loss is believed to cause aseptic loosening and failed prosthetic fixation in joint arthroplasty. This meta-analysis which included high-quality randomized controlled trials aimed to analyze the effect of bisphosphonates on maintaining periprosthetic bone mineral density after total joint arthroplasty. METHODS Twenty-five RCTs were included and the total number of participants was 1163 by computerized searches of bibliographic databases. The weighted mean differences with 95% confidence interval were calculated to evaluate the efficacy of BPs on total periprosthetic BMD and the BMD of different Gruen zones. Subgroup analyses identified the potentially influencing factors such as surgical site, cement fixation, and generation of BPs. A descriptive review was conducted for BP-related adverse effects. RESULTS The BPs group presented significantly higher total periprosthetic BMD in the BPs group than that in the control group at 3, 6, 12 months, 2-4 years, and 5-10 years after arthroplasty (P < 0.05). The BPs group presented significantly higher periprosthetic BMD in femoral Gruen Zone 1 and 7 than that in the control group at 3, 6, 12 months, 2-4 years, and 5-10 years (P < 0.05). The heterogeneity was minimized by dividing THA and TKA into two subgroups. Subgroup analyses revealed that the effect of BPs on preservation of BMD was significantly greater in arthroplasty with cemented component than in that with uncemented component at 12 months and 5-10 years (P < 0.05), and the administration of the second and third generation BPs was significantly more effective than the first-generation BPs at 6 and 12 months (P < 0.05). None of the included studies described severe or fatal adverse effects related to BPs. CONCLUSIONS BPs have significantly long-term efficacy on the preservation of periprosthetic BMD after joint arthroplasty. To obtain a better efficacy, the cemented components and the second and third generation BPs are recommended.
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Affiliation(s)
- M Shi
- Department of Orthopaedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, No.88 Jiefang Road, Hangzhou, 310009, People's Republic of China
| | - L Chen
- Department of Endocrinology and Metabolism, Sir Run Run Shaw Hospital Affiliated with School of Medicine, Zhejiang University, No. 3 Qingchun Road, Hangzhou, 310009, People's Republic of China
| | - Z Xin
- Department of Orthopaedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, No.88 Jiefang Road, Hangzhou, 310009, People's Republic of China
| | - Y Wang
- Department of Orthopaedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, No.88 Jiefang Road, Hangzhou, 310009, People's Republic of China
| | - W Wang
- Department of Orthopaedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, No.88 Jiefang Road, Hangzhou, 310009, People's Republic of China
| | - S Yan
- Department of Orthopaedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, No.88 Jiefang Road, Hangzhou, 310009, People's Republic of China.
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26
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Wang M, Wang L, Ye R. Risedronate reduces postoperative bone resorption after cementless total hip arthroplasty: A systematic review and meta-analysis. Int J Surg 2018; 52:189-200. [PMID: 29448032 DOI: 10.1016/j.ijsu.2018.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 01/29/2018] [Accepted: 02/04/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine the effects of risedronate for reducing periprosthetic bone loss after total hip arthroplasty (THA). METHODS Two reviewers performed an electronic literature search for randomized controlled trial (RCTs) evaluating the risedronate in the management of periprosthetic bone loss after primary THA. The electronic databases include PubMed, Medline, Embase, Web of Science and the Cochrane Library from inception to January 2018. We assessed the risk of bias using the Cochrane risk-of-bias tool. STATA 14.0 was used to perform the meta-analysis. RESULTS Four RCTs were included in our study. Current meta-analysis indicated that postoperative reduciton of periprosthetic BMD in the risedronate group was significantly lower than that in the placebo group in zones 1, 2, 3, 4, 6, and 7. There was no increased risk of adverse effects. CONCLUSION The administration of risedronate was associates with a significantly improved periprosthetic BMD after primary THA. No increased risk of adverse events were observed. Higher quality RCTs are still required for further research.
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Affiliation(s)
- Meng Wang
- Department of Joint Surgery, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, 315020, China
| | - Liang Wang
- Department of Joint Surgery, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, 315020, China
| | - Ruqing Ye
- Department of Joint Surgery, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, 315020, China.
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27
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Gao J, Gao C, Li H, Wang GS, Xu C, Ran J. Effect of zoledronic acid on reducing femoral bone mineral density loss following total hip arthroplasty: A meta-analysis from randomized controlled trails. Int J Surg 2017; 47:116-126. [PMID: 28827056 DOI: 10.1016/j.ijsu.2017.08.559] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 08/11/2017] [Accepted: 08/16/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This meta-analysis aimed to assess the efficiency of intravenous administration of zoledronic acid on reducing femoral periprosthetic bone mineral density loss in patients undergoing primary total hip arthroplasty (THA). METHODS A systematic search was performed in Medline (1966-2017.07.31), PubMed (1966-2017.07.31), Embase (1980-2017.07.31), ScienceDirect (1985-2017.07.31) and the Cochrane Library (1966-2017.07.31). Fixed/random effect model was used according to the heterogeneity tested by I2 statistic. Sensitivity analysis was conducted and publication bias was assessed. Meta-analysis was performed using Stata 11.0 software. RESULTS Four studies including 185 patients met the inclusion criteria. The present meta-analysis indicated that there were significant differences between groups in terms of periprosthetic bone mineral density in Gruen zone 1 (SMD = 0.752, 95% CI: 0.454 to 1.051, P = 0.000), 2 (SMD = 0.524, 95% CI: 0.230 to 0.819, P = 0.000), 4 (SMD = 0.400, 95% CI: 0.107 to 0.693, P = 0.008), 6 (SMD = 0.893, 95% CI: 0.588 to 1.198, P = 0.000) and 7 (SMD = 0.988, 95% CI: 0.677 to 1.300, P = 0.000). CONCLUSION Intravenous administration of zoledronic acid could significantly reduce periprosthetic bone mineral density loss (Gruen zone 1, 2, 4, 6 and 7) after THA. In addition, no severe adverse events were identified. High-quality RCTs with large sample size were still required.
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Affiliation(s)
- Jian Gao
- Department of Orthopaedics, The Sixth Affiliated Hospital of Xinjiang Medical University, Urumchi, 830002, China
| | - Chong Gao
- Department of Orthopaedics, The Second People's Hospital of Lianyungang, Lianyungang, 222006, China
| | - Hui Li
- Department of Cardiology, The Sixth Affiliated Hospital of Xinjiang Medical University, Urumchi, 830002, China
| | - Guo-Sheng Wang
- Department of Orthopaedics, The Sixth Affiliated Hospital of Xinjiang Medical University, Urumchi, 830002, China
| | - Chang Xu
- Department of Orthopaedics, The Sixth Affiliated Hospital of Xinjiang Medical University, Urumchi, 830002, China
| | - Jian Ran
- Department of Orthopaedics, The Sixth Affiliated Hospital of Xinjiang Medical University, Urumchi, 830002, China.
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