Effect of one-year post-operative alendronate treatment on periprosthetic bone after total knee arthroplasty. A seven-year randomised controlled trial of 26 patients.
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.
Kuopio University Hospital, Omakotitie 61, Kuopio, 70600, Finland.
A V J
AV
Jaroma
Central Hospital of North Carelia, Tikkamäentie 16, 80210 Joensuu, Finland.
T A
TA
Soininvaara
University of Eastern Finland, P.O. Box 100, 70029 KYS. Kuopio, Finland.
H
H
Kröger
D000368:Aged; D019386:Alendronate / Q000627:therapeutic use*; D019645:Arthroplasty, Replacement, Knee; D015519:Bone Density / Q000187:drug effects*; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D001862:Bone Resorption / Q000188:drug therapy* / Q000209:etiology; D002118:Calcium / Q000627:therapeutic use*; D004185:Disability Evaluation; D004359:Drug Therapy, Combination; D005260:Female; D005269:Femur / Q000601:surgery; D006801:Humans; D008297:Male; D020370:Osteoarthritis, Knee / Q000628:therapy*; D011183:Postoperative Complications; D011446:Prospective Studies; D012086:Reoperation; D016896:Treatment Outcome
D050071:Bone Density Conservation Agents; D002118:Calcium; D019386:Alendronate
Alendronate; DXA; Periprosthetic BMD; TKA