Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, California.
J Arthroplasty. 2024 Jun;39(6):1459-1462. doi: 10.1016/j.arth.2023.11.036. Epub 2023 Dec 7.
Many patients are diagnosed with osteoporosis shortly prior to scheduling total joint arthroplasty (TJA). The purpose of this study was to determine if initiation of bisphosphonates prior to TJA decreased the risks of periprosthetic fractures (PPFx).
A national database was used to identify all patients diagnosed with osteoporosis prior to primary TJA. Patients who had osteoporosis without preoperative bisphosphonate use were designated as our control group. Patients on preoperative bisphosphonates were stratified based on duration and timing of bisphosphonate use: long-term preoperative users (initiation 3 to 5 years preoperatively), intermediate-term preoperative users (initiation 1 to 3 years preoperatively), and short-term preoperative users (initiation 0 to 1 year preoperatively). Rates of PPFx at 90-day and 2-year follow-up were compared between groups.
In patients undergoing primary total hip arthroplasty, there was no difference in PPFx rate between our control group and preoperative bisphosphonate users of all durations at 90-day (P = .12) and 2-year follow-up (P = .22). In patients undergoing primary total knee arthroplasty, there was no difference in PPFx rate between our control group and preoperative bisphosphonate users of all durations at 90-day (P = .76) and 2-year follow-up (P = .39).
In patients undergoing primary TJA, preoperative bisphosphonate users did not have a decreased PPFx rate compared to our control group at 90-day and 2-year follow-up. Our findings suggest that preoperative bisphosphonate use, regardless of the duration of treatment, does not confer protective benefits against PPFx in patients undergoing TJA.
Prognostic Level III.
许多患者在安排全关节置换术（TJA）前不久被诊断为骨质疏松症。本研究旨在确定 TJA 前开始使用双膦酸盐是否降低了假体周围骨折（PPFx）的风险。
使用国家数据库确定所有在初次 TJA 前被诊断为骨质疏松症的患者。未在术前使用双膦酸盐的骨质疏松症患者被指定为我们的对照组。根据双膦酸盐使用的持续时间和时间将术前使用双膦酸盐的患者分层：长期术前使用者（术前 3 至 5 年开始）、中期术前使用者（术前 1 至 3 年开始）和短期术前使用者（术前 0 至 1 年开始）。比较各组在 90 天和 2 年随访时的 PPFx 发生率。
在接受初次全髋关节置换术的患者中，在 90 天（P=0.12）和 2 年随访（P=0.22）时，我们的对照组与所有持续时间的术前双膦酸盐使用者之间的 PPFx 发生率没有差异。在接受初次全膝关节置换术的患者中，在 90 天（P=0.76）和 2 年随访（P=0.39）时，我们的对照组与所有持续时间的术前双膦酸盐使用者之间的 PPFx 发生率没有差异。
在接受初次 TJA 的患者中，与我们的对照组相比，术前使用双膦酸盐的患者在 90 天和 2 年随访时的 PPFx 发生率没有降低。我们的研究结果表明，无论治疗持续时间如何，术前使用双膦酸盐并不能为接受 TJA 的患者提供对 PPFx 的保护作用。
预后 III 级。
