Perioperative Use of Bisphosphonate and Implant Survival After Total Joint Arthroplasty.

Abstract

The aim of this study was to explore the relationship between perioperative bisphosphonate (BP) use and implant survival in total joint arthroplasty (TJA). Literature in PubMed, EMBASE, and the Cochrane Library was systematically searched until May 2024, and studies were reviewed. Eligible studies are randomized controlled trials or cohort studies comparing BP with placebo or antiosteoporosis agents in TJA, reporting implant survival outcomes with full-text availability. The search identified 2,051 potentially relevant publications; 20 met the selection criteria. Our results revealed that perioperative BP use significantly reduced the incidence of all-cause revision surgery (ARS) after TJA (RR [risk ratio] 0.67 [95% CI (confidence interval) 0.54 to 0.83], P = 0.003). Preoperative BP use significantly increased the risk of developing ARS (RR 0.72 [95% CI 0.54 to 0.95], P < 0.00001) and periprosthetic fracture (PPF) (RR 1.33 [95% CI 1.21 to 1.46], P < 0.00001) after TJA. However, BP initiated after TJA reduced the risk of ARS (RR 0.57 [95% CI 0.43 to 0.74], P < 0.00001). In addition, perioperative BP use for at least six months was associated with a lower risk of ARS (RR 0.83 [95% CI 0.77 to 0.89], P < 0.00001), but a higher risk of PPF in patients who had TJA (RR 1.28 [95% CI 1.16 to 1.42], P = 0.0002). When initiated after total hip arthroplasty (THA), BP was associated with a lower incidence of PPF (RR 0.55 [95% CI 0.31 to 0.98], P = 0.04), and there was an increased risk of ARS following THA if perioperative BP was used for over one year (RR 1.10 [95% CI 1.01 to 1.21], P = 0.03). At last, perioperative BP use had no effect on aseptic loosening, periprosthetic joint infection, osteolysis, stress fracture, adverse events, or mortality after TJA. Perioperative BP use significantly reduced the incidence of ARS after TJA. Preoperative use of BP significantly increased the risk of developing ARS and PPF after TJA. However, BP initiated after TJA reduced the risk of ARS, but had no effect on PPF. In addition, perioperative BP use for at least six months was associated with a lower risk of ARS, but a higher risk of PPF in patients who had TJA.