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JRPMS Vol 5, No 1, March 2021, p.1-7

doi: 10.22540/JRPMS-05-001


Review Article

The action of anti-resorptive drugs on the survival of total knee and hip arthroplasty

Ioannis Pitropakis

  • Postgraduate Program “Metabolic Bone Diseases”, National and Kapodistrian University of Athens, Medical School, Athens, Greece

Keywords: Antiresorptive agents, Bisphosphonates, Implant survival


Total knee and hip arthroplasty are major surgical procedures performed in patients with severe osteoarthritis and their incidence has significantly increased in the last 30 years. A number of etiological factors such as low grade infections, stress shielding and degradation products have been, however, shown to endanger the survival of the implants. The prevention of mechanically induced implant loosening has been the aim of many studies investigating, among other things, whether pharmaceutical agents used for the treatment of osteoporosis can positively influence the survival of the arthroplasty implants. We conducted a search of the published literature (PubMed) to identify studies that assessed the effects of anti-resorptive agents (bisphosphonates, denosumab, raloxifene, bazedoxifene, calcitonin) on the outcome and longevity of total arthroplasty of the hip and knee. We found 24 studies for THR, 8 studies for TKR and 2 studies with reference in both hip and knee arthroplasty. Most studies assessed the effects of oral bisphosphonates. Significant difference in BMD is observed after 6 months of postoperative antiosteoclastic therapy with better results and lower revision rate in cemented TKA. Only 2 studies were found assessing the effects of denosumab on implant survival, while no studies were found on SERMs and calcitonin.