Bisphosphonate Use Ups Knee, Hip Implant Survival

Almost two-fold increase seen in implant survival time after total knee or hip arthroplasty

WEDNESDAY, Dec. 7 (HealthDay News) -- Bisphosphonate use in patients undergoing total knee or hip arthroplasty is associated with significantly longer implant survival and time to revision, according to a study published online Dec. 6 in BMJ.

Daniel Prieto-Alhambra, M.D., Ph.D., from the University of Oxford in the United Kingdom, and colleagues investigated whether bisphosphonate use was associated with improved implant survival after total arthroplasty of the knee or hip. Of 41,995 individuals analyzed between 1986 and 2006, 18,726 and 23,269 underwent primary total knee and hip arthroplasty, respectively. Patients with at least six bisphosphonate prescriptions, or more than 80 percent adherence to at least six months of prescribed bisphosphonate treatment before revision surgery, were classified as bisphosphonate users (1,912). Patients who were younger than 40 years at surgery, or who had a history of rheumatoid arthritis or hip fracture before surgery, were excluded. Post-surgery revision arthroplasties were identified. The effects on implant survival were determined through propensity score-adjusted parametric survival models.

The investigators found that, compared to nonusers, bisphosphonate users had a lower revision rate at five years (0.93 versus 1.96 percent). Propensity adjusted models showed that bisphosphonate users had significantly longer implant survival than non-users (hazard ratio, 0.54; P = 0.047), and a nearly two-fold increase in the time to revision following hip or knee arthroplasty (time ratio, 1.96)

"In patients undergoing lower limb arthroplasty, bisphosphonate use was associated with an almost two-fold increase in implant survival time," the authors write.

Several authors disclosed financial relationships with pharmaceutical companies, including Merck, Sharpe and Dohme, and Novartis, which partially funded the study.

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