Wiener klinische Wochenschrift

, Volume 118, Supplement 2, pp 23–28 | Cite as

Effect of etidronate in preventing periprosthetic bone loss following cemented hip arthroplasty: A randomized, double blind, controlled trial

  • Samo K. Fokter
  • Radko Komadina
  • Alenka Repše-Fokter
Original Article

Summary

INTRODUCTION: Periprosthetic bone loss occurs after insertion of a total hip prosthesis and is often a result of stress shielding or altered loading of the proximal femur. Preventing the bone loss, which may threaten the prosthesis survival, with an antiresorptive drug would be highly advantageous. MATERIALS AND METHODS: Our study investigated the effect of cyclic etidronate therapy on periprosthetic, contralateral hip, and spine bone mineral density (BMD) in a one-year, prospective, randomized, double-blind study in 31 patients after cemented hip arthroplasty. Etidronate was taken orally in a regimen repeated every 14 weeks, and periprosthetic BMD was measured with dual energy X-ray absorptiometry (DXA) in the total periprosthetic area and in the seven Gruen zones at 1 week (baseline), 6 weeks, 3 months, 6 months, and 12 months postoperatively. RESULTS: In the etidronate group there were significant temporal BMD decreases measured in Gruen zones 2, 3, 6, and 7 and in the entire proximal femur; the greatest decrease was 12.9% and was measured in zone 7 at six months. Also in the etidronate group, there was a significant 2.8% temporal BMD increase in the spine at 12 months. In the placebo group there were significant temporal BMD decreases measured in Gruen zones 1, 2, 3, 5, 6, and 7 and in the entire proximal femur; the greatest decrease was 25.5% and was measured in zone 7 at 12 months. There were no significant differences between the mean BMD measurements of the etidronate and placebo groups. CONCLUSION: These findings suggest that cyclic etidronate therapy has no significant effect in suppressing periprosthetic bone loss after cemented hip arthroplasty.

Keywords

Clinical trials Implants Total hip arthroplasty Bone densitometry Bisphosphonates 

References

  1. Reiter A, Sabo D, Simank HG, Buchner T, Seidel M, Lukoschek M (1997) Periprosthetic mineral density in cement-free hip replacement arthroplasty. Z Orthop Grenzgeb 135: 499–504CrossRefGoogle Scholar
  2. Venesmaa PK, Kroger HP, Miettinen HJ, Jurvelin JS, Suomalainen OT, Alhava EM (2001) Monitoring of periprosthetic BMD after uncemented total hip arthroplasty with dual-energy X-ray absorptiometry: a 3-year followup study. J Bone Miner Res 16: 1056–1061PubMedCrossRefGoogle Scholar
  3. Oh I, Harris WH (1987) Proximal strain distribution in the loaded femur: an in vitro comparison of the distributions in the intact femur and after insertion of different hip-replacement femoral components. J Bone Joint Surg Am 60: 75–83Google Scholar
  4. Willert HG, Buchhorn GH (1999) The biology of the loosening of hip implants. In: Jakob RP, Fulford P, Horan F (eds) European instructional course lectures, vol 4. The British Editorial Society of Bone and Joint Surgery, London, pp 58–82Google Scholar
  5. Duncan CP, Masterson EL, Masri BA (1998) Impaction allografting with cement for the management of femoral bone loss. Orthop Clin North Am 29: 297–305PubMedCrossRefGoogle Scholar
  6. Dunn CJ, Fitton A, Sorkin EM (1994) Etidronic acid: a review of its pharmacological properties and therapeutic efficacy in resorptive bone disease. Drugs Aging 5: 446–474PubMedCrossRefGoogle Scholar
  7. Cranney A, Guyatt G, Krolicki N, Welch V, Griffith L, Adachi JD, et al (2001) A meta-analysis of etidronate for the treatment of postmenopausal osteoporosis. Osteoporos Int 12: 140–151PubMedCrossRefGoogle Scholar
  8. Venesmaa PK, Kroger HP, Miettinen HJ, Jurvelin JS, Suomalainen OT, Alhav EM (2001) Alendronate reduces periprosthetic bone loss after uncemented primary total hip arthroplasty: a prospective randomized study. J Bone Miner Res 16: 2126–2131PubMedCrossRefGoogle Scholar
  9. Wilkinson JM, Stockley I, Peel NF, Hamer AJ, Elson RA, Barrington NA, et al (2001) Effect of pamidronate in preventing local bone loss after total hip arthroplasty: a randomized, double-blind, controlled trial. J Bone Miner Res 16: 556–564PubMedCrossRefGoogle Scholar
  10. Nehme A, Maalouf G, Tricoire JL, Giordano G, Chiron P, Puget J (2003) Effect of alendronate on periprosthetic bone loss after cemented primary total hip arthroplasty: a prospective randomized study. Rev Chir Orthop Reparatrice Appar Mot 89: 593–598PubMedGoogle Scholar
  11. Yamaguchi K, Masuhara K, Yamasaki S, Nakai T, Fuji T (2003) Cyclic therapy with etidronate has a therapeutic effect against local osteoporosis after cementless total hip arthroplasty. Bone 33: 144–149PubMedCrossRefGoogle Scholar
  12. Gruen TA, McNeice GM, Amstutz HC (1979) "Modes of failure" of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop 141: 17–27PubMedGoogle Scholar
  13. Fleisch HA (1997) Bisphosphonates: preclinical aspects and use in osteoporosis. Ann Med 29: 55–62PubMedGoogle Scholar
  14. Harris ST, Watts NB, Jackson RD, Genant HK, Wasnich RD, Ross P, et al (1993) Four-year study of intermittent cyclic etidronate treatment of postmenopausal osteoporosis: three years of blinded therapy followed by one year of open therapy. Am J Med 95: 557–567PubMedCrossRefGoogle Scholar
  15. Cortet B, Bera-Louville A, Gauthier P, Gauthier A, Marchandise X, Delcambre D (2001) Comparative efficacy and safety of etidronate and alendronate in postmenopausal osteoporosis. Effect of adding hormone replacement therapy. Joint Bone Spine 68: 410–415PubMedCrossRefGoogle Scholar
  16. Cohen B, Rushton N (1995) Accuracy of DEXA measurement of bone mineral density after total hip arthroplasty. J Bone Joint Surg Br 77: 479–483PubMedGoogle Scholar
  17. Wilkinson JM, Peel NF, Elson RA, Stockley I, Eastell R (2001) Measuring bone mineral density of the pelvis and proximal femur after total hip arthroplasty. J Bone Joint Surg Br 83: 283–288PubMedCrossRefGoogle Scholar
  18. Marchetti ME, Steinberg GG, Greene JM, Jenis LG, Baran DT (1996) A prospective study of proximal femur bone mass following cemented and uncemented hip arthroplasty. J Bone Miner Res 11: 1033–1039PubMedCrossRefGoogle Scholar
  19. Trevisan C, Bigoni M, Randelli G, Marinoni EC, Peretti G, Ortolani S (1997) Periprosthetic bone density around fully hydroxyapatite coated femoral stem. Clin Orthop 340: 109–117PubMedGoogle Scholar
  20. Venesmaa PK, Kröger HP, Jurvelin JS, Miettinen HJ, Suomalainen OT, Alhava EM (2003) Periprosthetic bone loss after cemented total hip arthroplasty: a prospective 5-year dual energy radiographic absorptiometry study of 15 patients. Acta Orthop Scand 74: 31–36PubMedCrossRefGoogle Scholar
  21. Bhandari M, Bajammal S, Guyatt GH, Griffith L, Busse JW, Schunemann H, Einhorn TA (2005) Effect of bisphosphonates on periprosthetic bone mineral density after total joint arthroplasty. A meta-analysis. J Bone Joint Surg Am 87: 293–301PubMedCrossRefGoogle Scholar
  22. Wilkinson JM, Eagleton AC, Stockley I, Peel NF, Hamer AJ, Eastell R (2005) Effect of pamindronate on bone turnover and implant migration after total hip arthroplasty: a randomized trial. J Orthop Res 23: 1–8PubMedCrossRefGoogle Scholar
  23. Tucci JR, Tonino RP, Emkey RD, Peverly CA, Kher U, Santora II AC (1996) Effect of three years of oral alendronate treatment in postmenopausal women with osteoporosis. Am J Med 101: 488–501PubMedCrossRefGoogle Scholar
  24. Pols HA, Felsenberg D, Hanley DA, Stepan J, Munoz-Torres M, Wilkin TJ, et al (1999) Multinational, placebocontrolled, randomized trial of the effects of alendronate on bone density and fracture risk in postmenopausal women with low bone mass: results of the FOSIT study. Foxamax International Trial Study Group. Osteoporos Int 9: 461–468PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Samo K. Fokter
    • 1
  • Radko Komadina
    • 2
  • Alenka Repše-Fokter
    • 3
  1. 1.Department of Orthopedic Surgery and Sports TraumaCelje General HospitalCeljeSlovenia
  2. 2.Department of TraumaCelje General HospitalCeljeSlovenia
  3. 3.Department for Pathology and CytopathologyCelje General HospitalCeljeSlovenia

Personalised recommendations