[Effect of alendronate on periprosthetic bone loss after cemented primary total hip arthroplasty: a prospective...

Bone remodeling and osteolysis around total hip prostheses, with its inevitable corollary, prosthesis loosening, remains a difficult problem in orthopedic surgery. Alendronate (bisphosphonate) has proven its efficacy for the treatment of osteoporosis of the lumbar spine and femoral neck. A few in vitro studies have pointed out its inhibiting effect on particle-induced osteolysis. In vivo, one study has demonstrated its usefulness in preventing osteolysis around non-cemented total hip arthroplasties (THA). The purpose of this work was to study the efficacy of this agent for the prevention of changes in peri-prosthetic bone mineral density (BMD) after primary THA.

The study series included 38 patients with degenerative hip disease who underwent THA. The patients were randomized in double-blind fashion to two treatment arms: 10 alendronate and 600 mg calcium per day for 2 years (20 patients) or placebo and 600 mg calcium per day for 2 years (18 patients). Conventional x-rays and x-ray biphotonic absorptiometry (DPX) was performed on day four postop and at 3, 6, 12, and 24 months postop. The periprosthetic zones described by Grüen were used for analysis.

DPX demonstrated a significant reduction in BMD in all patients included in the study. The bone loss was the same in both groups during the early postoperative period reaching maximum loss at 3 months. Differences were observed after this time. In the placebo group, bone loss reached a plateau at 6 months then BMD started to increase progressively, reaching 12.7% bone loss at 2 years follow-up (p<0.002). In the alendronate group, there was no plateau, BMD increased continuously starting from three months and reached 6.857% bone loss at 2 years (p<0.003).

Administration of alendronate led to a significant reduction in peri-prosthetic bone loss at 2 years follow-up. These results are the first to our knowledge demonstrating the beneficial effect in vivo of alendronate on bone behavior around cemented THAs.

This beneficial effect observed in vivo should be confirmed in further studies including a larger number of patients and longer follow-up. The action of alendronate could facilitate and even retard revision surgery by preserving bone stock.