title: Local bisphosphonate reduces migration and formation of radiolucent lines adjacent to cemented acetabular components.
abstract: OBJECTIVE
  Post-operative migration of cemented acetabular components as measured by radiostereometric analysis (RSA) has a strong predictive power for late, aseptic loosening. Also, radiolucent lines predict late loosening. Migration has been reduced by systemic bisphosphonate treatment in randomised trials of hip and knee arthroplasty. Used as a local treatment, a higher local dose of bisphosphonate can be achieved without systemic exposure. We wished to see if this principle could be applied usefully in total hip arthroplasty (THA).
  
  
  METHODS
  In this randomised placebo-controlled, double-blinded trial with 60 participants, we compressed gauze soaked in bisphosphonate solution (ibandronate) or saline against the acetabular bone bed immediately before cementing the acetabular component. RSA, classification of radiolucent lines, the Harris Hip Score (HHS) and the Western Ontario McMasters Universities Osteoarthritis Index (WOMAC) were carried out at three-, six-, 12-, and 24-month follow-up.
  
  
  RESULTS
  Migration of the cemented acetabular component relative to the pelvis was reduced by movement almost half in the ibandronate group, when measured as maximum total point or as movement of the femoral head (p = 0.001 and 0.004, respectively). Radiolucent lines after one year were classified as absent, partial or complete, and correlated with treatment (rho 0.37; p = 0.004). Only three of 30 patients in the ibandronate group had complete lines, compared with 13 of 28 in the placebo group (p = 0.002). There were no significant effects on HHS or WOMAC score.
  
  
  CONCLUSIONS
  Considering the power of RSA to predict loosening of cemented acetabular components, and the likelihood that radiolucent lines indicate risk of loosening, these data suggest that local treatment with a bisphosphonate can reduce the risk of late aseptic loosening. Cite this article:Bone Joint J2017;99-B:317-24.
authors.affiliation: Linköping University, Linköping, Sweden.
authors.forename: J
authors.initials: J
authors.lastname: Schilcher
authors.affiliation: Linköping University, Linköping, Sweden.
authors.forename: L
authors.initials: L
authors.lastname: Palm
authors.affiliation: Linköping University, Linköping, Sweden.
authors.forename: I
authors.initials: I
authors.lastname: Ivarsson
authors.affiliation: Linköping University, Linköping, Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Aspenberg
mesh_terms: D000077:Acetabulum / Q000000981:diagnostic imaging / Q000601:surgery*; D000287:Administration, Topical; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation* / Q000379:methods; D001843:Bone Cements; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002484:Cementation; D004164:Diphosphonates / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D005548:Foreign-Body Migration / Q000000981:diagnostic imaging / Q000517:prevention & control*; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D000077557:Ibandronic Acid; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000601:surgery; D011474:Prosthesis Design; D011475:Prosthesis Failure / Q000187:drug effects; D059869:Radiostereometric Analysis; D012720:Severity of Illness Index
chemical_list: D001843:Bone Cements; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D000077557:Ibandronic Acid
keywords: Bisphosphonates; Implant loosening; Radiostereometric analysis; Total hip arthroplasty