0
Scientific Articles   |    
The Effect of a Single Infusion of Zoledronic Acid on Early Implant Migration in Total Hip ArthroplastyA Randomized, Double-Blind, Controlled Trial
Gerald Friedl, MD1; Roman Radl, MD1; Christoph Stihsen, MD1; Peter Rehak, PhD1; Reingard Aigner, MD1; Reinhard Windhager, MD1
1 University Clinic of Orthopaedic Surgery (G.F., R.R., C.S., and R.W.), Department of Surgery, Unit for Biomedical Engineering and Computing (P.R.), and Division of Nuclear Medicine, Department of Radiology (R.A.), Medical University of Graz, AT-8036 Graz, Austria. E-mail address for G. Friedl: gerald.friedl@medunigraz.at. E-mail address for R. Radl: roman.radl@medunigraz.at. E-mail address for C. Stihsen: christoph_sti@gmx.at. E-mail address for P. Rehak: peter.rehak@medunigraz.at. E-mail address for R. Aigner: reingard.aigner@medunigraz.at. E-mail address for R. Windhager: reinhard.windhager@medunigraz.at
View Disclosures and Other Information
Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. One or more of the authors or a member of his or her immediate family received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from commercial entitities (DePuy Orthopaedics and Orthovita). Also, a commercial entity (DePuy Orthopaedics) paid or directed in any one year, or agreed to pay or direct, benefits in excess of $10,000 to a research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which one or more of the authors, or a member of his or her immediate family, is affiliated or associated.
A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM/DVD (call our subscription department, at 781-449-9780, to order the CD-ROM or DVD).
Investigation performed at the Medical University of Graz, Graz, Austria

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2009 Feb 01;91(2):274-281. doi: 10.2106/JBJS.G.01193
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case

Abstract

Background: Aseptic loosening is the most frequent cause of implant failure in total hip arthroplasty. While a direct link between aseptic loosening and periprosthetic bone loss remains elusive, there is plentiful evidence for a close association with early implant migration. The present trial was primarily designed to evaluate whether a single infusion of 4 mg of zoledronic acid prevented early implant migration in patients with osteonecrosis of the femoral head.

Methods: Fifty patients were consecutively enrolled to receive either zoledronic acid or saline solution after cementless total hip arthroplasty. Radiographs, biochemical parameters of bone turnover, and the Harris hip-rating score were determined preoperatively and at each follow-up examination at seven weeks, six months, one year, and yearly thereafter. The median follow-up period was 2.8 years.

Results: We found a significant subsidence of the stem of up to a mean (and standard deviation) of -1.2 ± 0.6 mm at two years within the control group, and the cups had a mean medialization of 0.6 ± 1.0 mm and a mean cranialization of 0.6 ± 0.8 mm (p < 0.001). Treatment with zoledronic acid effectively minimized the migration of the cups in both the transverse and the vertical direction (mean, 0.15 ± 0.6 mm and 0.06 ± 0.6 mm, respectively; p < 0.05), while only a trend to decreased subsidence of the stem was detected. Finally, the Harris hip score rapidly increased over time in both treatment groups, although this increase was significantly more pronounced in the zoledronate-treated group than in the control group (analysis of variance, p = 0.008).

Conclusions: A single infusion of zoledronic acid shows promise in improving initial fixation of a cementless implant, which may improve the clinical outcome of total hip arthroplasty in patients with osteonecrosis of the femoral head.

Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.

Figures in this Article
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

     
    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org

    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe





    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Topic Collections
    Hip
    Related Audio and Videos
    PubMed Articles
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    05/03/2012
    California - UCLA/OH Department of Orthopaedic Surgery
    11/15/2013
    Louisiana - Ochsner Health System
    03/19/2014
    Virginia - VIRGINIA COMMONWEALTH UNIVERSITY MEDICAL CENTER