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Effect of pamidronate on bone turnover and implant migration after total hip arthroplasty: A randomized trial
Author(s) -
Wilkinson J. Mark,
Eagleton Alison C.,
Stockley Ian,
Peel Nicola F. A.,
Hamer Andrew J.,
Eastell Richard
Publication year - 2005
Publication title -
journal of orthopaedic research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.041
H-Index - 155
eISSN - 1554-527X
pISSN - 0736-0266
DOI - 10.1016/j.orthres.2004.06.004
Subject(s) - periprosthetic , medicine , bone remodeling , calcar , femur , surgery , bone mineral , implant , femoral neck , urology , arthroplasty , dentistry , osteoporosis
In this trial we studied the effect of pamidronate on periprosthetic bone turnover and pelvic implant migration over 2 years after hybrid total hip arthroplasty (THA). Twenty‐two patients received 90 mg of pamidronate and 22 received placebo at randomization 5 days after surgery. Rapid periprosthetic bone loss occurred in the placebo group over the first 6 months and was accompanied by transient increases in biochemical markers of bone turnover. Partial recovery in bone mass occurred in most region after this period. No recovery of bone mass occurred at the femoral calcar or the medical wall of the acetabulum. Femoral calcar bone loss at 2 years was strongly predicted by acute biomarker changes at week 6. Pamidronate therapy reduced femoral bone loss in the region of the femoral calcar ( P =0.01), but did not affect pelvic bone loss. Pamidronate therapy also inhibited the transient rise in biochemical markers of bone turnover during this period. Pamidronate therapy did not affect acetabular cup migration. Cup migration was inversely related to subject age, but unrelated to initial post‐operative bone mineral density, or subsequent bone loss. In summary, early periprosthetic bone loss is associated with a transient expansion of the bone remodeling space. Bisphosphonate therapy reduces femoral calcar bone loss and bone turnover after THA, but did not influence cup migration in this study. Acute changes in biochemical markers predict femoral periprosthetic bone loss. © 2004 Orthopaedic Research Society. Published by Elsevier Ltd. All rights reserved.