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Rinsing allografts with bisphosphonate can help prevent resorption, study suggests
Bisphosphonate-treated allografts had a mean 2% increase in bone density at 3 months follow-up.
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Rinsing morcellized bone grafts with a bisphosphonate before implantation appears to help prevent graft resorption following revision total hip replacement. It may also reduce the risk for mechanical failure, according to a prospective study.
Uldis Kesteris, MD, PhD, and colleagues in Sweden randomly assigned 16 patients undergoing revision THR to receive allografts rinsed in either 60 mg/ml of ibandronate (Bonefos, Schering Nordiska) or a placebo solution of normal saline.
Patients had a mean age of 70 years at the time of revision. None had been using bisphosphonates prior to surgery or during the two-year postoperative follow-up, according to the study, published in the British edition of Journal of Bone and Joint Surgery.
The final data analysis included 7 bisphosphonate-treated patients and 8 control patients.
The researchers found that the control group had a 9% decrease in bone density at 3 months follow-up. In contrast, patients who received the bisphosphonate-treated allografts had a mean 2% increase in bone density, which appeared to be maintained at subsequent follow-up points.
Additionally, control patients had a significant calcium loss at 3 months compared to patients treated with bisphosphonates (P=.001), according to the study.
“In the control patients the grafts were already partially resorbed after 3 months, whereas the grafts treated with bisphosphonate increased in density in the beginning and then remained unchanged for two years,” the study authors said.
Patients in both groups had decreases in bone mineral content, averaging 1.9 g among bisphosphonate-treated patients and 3.1 g among control patients. However, there were no significant changes in the cortical region between groups, the authors noted.
“Clinical follow-up showed that all the revised stems were in situ and had no radiographic signs of loosening,” they said.
One bisphosphonate-treated patient did require an acetabular component revision after 3 years, “probably as a result of repeated trauma because of two falls from a height of 2.5 m and a bicycle accident,” they said.
For more information:
- Kesteris U, Aspenberg P. Rinsing morcellised bone grafts with bisphosphonate solution prevents their resorption. J Bone Joint Surg Br. 2006;88-B:993-996.