Archief Roodbont

The most common indication for revision hip or knee arthroplasty is implant loosening caused by resorption of bone that supports the implant. In this population-based retrospective cohort study, investigators assessed whether use of bisphosphonates, which have antiresorptive properties, can lengthen implant survival.

Using the U.K.'s General Practice Research Database, researchers identified 42,000 patients who underwent primary total knee or hip arthroplasty from 1986 through 2006. At 5 years, bisphosphonate users (essentially defined as those who took bisphosphonates for at least 6 months) had a significantly lower revision rate than nonusers (0.93% vs. 1.96%). In analyses adjusted for confounding factors, bisphosphonate use was associated with a significant twofold increase in implant survival. Assuming an arthroplasty failure rate of 2% during 5 years, the authors estimated that 107 patients who underwent primary hip or knee arthroplasty would need to be treated with bisphosphonates to prevent one revision arthroplasty.

Comment: As the authors note, revision hip or knee arthroplasty has "a poorer clinical outcome than primary joint surgery and is more costly." Needless to say, patients (and their physicians) would like to avoid this outcome. These results suggest that bisphosphonate use is associated with a lower rate of hip and knee revision arthroplasty and longer implant survival.

— Paul S. Mueller, MD, MPH, FACP

Published in Journal Watch General Medicine January 3, 2012