Predictions on preserving bone mass in knee arthroplasty with bisphosphonates

Using a computational model of bone adaptation, we investigated the long-term ability of bisphosphonates to minimize proximal bone loss that is associated with stress shielding in the tibia after long-stemmed total knee arthroplasty (TKA). When invoking bisphosphonate effects, the remodeling activity was suppressed, and the resorption size was reduced. Compared with the untreated simulation, bisphosphonate slowed the rate of bone loss after TKA (42% reduction in bone loss at 1 year). Activating the drug 3 months before the surgery reversed bone loss associated with the reduction in such activities as walking, but it did not provide any substantial benefit in the long-term. Late bisphosphonate treatment did not reverse the bone loss that occurred 3.5 years after TKA, although it preserved 3% of bone normally lost without treatment.