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13.12.2018 | KNEE | Ausgabe 7/2019

Knee Surgery, Sports Traumatology, Arthroscopy 7/2019

The use of bisphosphonates after joint arthroplasty is associated with lower implant revision rate

Zeitschrift:
Knee Surgery, Sports Traumatology, Arthroscopy > Ausgabe 7/2019
Autoren:
Du Hyun Ro, Heejin Jin, Jae-Young Park, Myung Chul Lee, Sungho Won, Hyuk-Soo Han
Wichtige Hinweise
Du Hyun Ro and Heejin Jin contributed equally to this work.
Sungho Won and Hyuk-soo Han contributed equally to this work.

Abstract

Purpose

This study hypothesized that the use of bisphosphonates (BPs) after total joint arthroplasty (TJA) is associated with a lower implant revision rate. This study aimed (1) to investigate the association between BP use and the revision rate of TJA and (2) to determine the relationship between the medication period and the revision rate of TJA.

Methods

National Health Insurance Service data on surgeries, medications, diagnoses, and screenings of 50 million Koreans were reviewed. People who underwent TJA in the period from 2002 to 2012 were identified and followed until 2016. During that period, 331,660 patients underwent total knee arthroplasty (TKA), and 56,043 patients underwent total hip arthroplasty (THA). Among them, 8447 knee patients (2.5%) and 2851 hip patients (5.0%) required revision surgery due to aseptic loosening. Demographic data, the duration of BP medication, and comorbidities were identified. The rate of revision surgery according to BP medication was investigated. The extended Cox proportional hazard model was used to evaluate the effect of the medication period.

Results

The rate of TKA revision was 1.4% for BP users and 2.9% for BP non-users (p < 0.001). The THA revision rate was 2.8% and 5.3% for BP users and non-users, respectively (p < 0.001). The hazard ratio (HR) of revision was significantly lower in patients who took BP medication for more than one year (TKA HR = 0.472, 95% CI [0.350–0.637]; THA HR = 0.490, 95% CI [0.247–0.972]) compared to that in short-term users (less than 1 year).

Conclusions

The use of BPs after TJA was associated with a lower revision rate. The use of BPs for more than one year further reduced the risk of revision. Bisphosphonate use can be highly recommended to reduce the revision rate of TJA.

Level of evidence

Retrospective cohort study, Level III.

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