Bisphosphonate Use and Risk of Implant Revision after Total Hip/Knee Arthroplasty: A Meta-Analysis of Observational Studies

Songsong Teng, Chengqing Yi, Christian Krettek, Michael Jagodzinski, Songsong Teng, Chengqing Yi, Christian Krettek, Michael Jagodzinski

Abstract

Objective: Several studies investigated the association between bisphosphonate use and the risk of implant revision after total hip or knee arthroplasty (THA or TKA); However, the findings were inconsistent. We performed this meta-analysis to evaluate the overall relative risk of such an event.

Methods: We searched the PubMed, EMBASE and Cochrane library databases to identify relevant publications on April 22, 2015. To calculate the pooled risk ratios (RRs) with 95% confidential intervals (CIs), a fixed- or random-effects model was applied based on the heterogeneity across studies.

Results: Three cohort studies and one case-control study were included in this meta-analysis. Compared with the bisphosphonate nonusers, the patients who used bisphosphonates for a long period of time had a significantly decreased risk of implant revision after THA/TKA (summary adjusted RR = 0.48, 95% CI: 0.38-0.61), and the summary adjusted RRs for the users who underwent THA and those who underwent TKA were 0.47 (95% CI: 0.36-0.61) and 0.45 (95% CI: 0.21-0.95), respectively.

Conclusions: Long-term use of bisphosphonates is correlated with a significantly decreased risk of implant revision after THA/TKA. However, due to limited number of the included studies, the findings of the present study should be treated with caution. More well-designed studies are required to further confirm our findings.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Flow chart of the selection…
Fig 1. Flow chart of the selection of the publications.
Fig 2. Forest plot of the association…
Fig 2. Forest plot of the association between bisphosphonate use and risk of implant revision after total hip/knee arthroplasty (A: adjusted RR; B: crude RR).
Fig 3. Forest plot of the association…
Fig 3. Forest plot of the association between bisphosphonate use and risk of implant revision after total knee arthroplasty (A: adjusted RR; B: crude RR).
Fig 4. Forest plot of the association…
Fig 4. Forest plot of the association between bisphosphonate use and risk of implant revision after total hip arthroplasty (A: adjusted RR; B: crude RR).
Fig 5. Forest plot of the association…
Fig 5. Forest plot of the association between preoperative bisphosphonate use and risk of implant revision after total hip/knee arthroplasty.

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