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Decreased migration with locally administered bisphosphonate in cemented cup revisions using impaction bone grafting technique : A randomized, controlled study evaluated with RSA and DXA with a 2-year follow-up

Zampelis, Vasileios LU ; Belfrage, Ola LU ; Tägil, Magnus LU ; Sundberg, Martin LU and Flivik, Gunnar LU (2018) In Acta Orthopaedica 89(1). p.17-22
Abstract

Background and purpose — Impaction bone grafting (IBG) in revision hip surgery is an established method in restoring bone stock deficiencies. We hypothesized that local treatment of the morsellized allograft with a bisphosphonate in cemented revision would, in addition to increased bone density, also reduce the early migration of the cup as measured by radiostereometry (RSA). Patients and methods — 20 patients with aseptic cup loosening underwent revision using the IBG technique. The patients were randomized to either clodronate (10 patients) or saline (10 patients, control group) as local adjunct to the morsellized bone. The outcome was evaluated by dual-energy X-ray absorptiometry (DXA) during the first year regarding periacetabular... (More)

Background and purpose — Impaction bone grafting (IBG) in revision hip surgery is an established method in restoring bone stock deficiencies. We hypothesized that local treatment of the morsellized allograft with a bisphosphonate in cemented revision would, in addition to increased bone density, also reduce the early migration of the cup as measured by radiostereometry (RSA). Patients and methods — 20 patients with aseptic cup loosening underwent revision using the IBG technique. The patients were randomized to either clodronate (10 patients) or saline (10 patients, control group) as local adjunct to the morsellized bone. The outcome was evaluated by dual-energy X-ray absorptiometry (DXA) during the first year regarding periacetabular bone density and with radiostereometric analysis (RSA) for the first 2 years regarding cup migration. Results — 2 patients were lost to follow-up: 9 patients remained in the clodronate and 9 in the control group. Less proximal migration was found in the clodronate group compared with the controls, measured both over time (mixed-models analysis, p = 0.02) as well as at the specified time points up to 2 years (0.22 mm and 0.59 mm respectively, p = 0.02). Both groups seemed to have stabilized at 1 year. We found similar bone mineral density measured by DXA, and similar RSA migration in the other directions. No cups were re-revised. Interpretation — Local treatment of the allograft bone with clodronate reduced early proximal migration of the revised cup but without any measurable difference in periacetabular bone density.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
bisphosphonate, bone grafting , RCT
in
Acta Orthopaedica
volume
89
issue
1
pages
17 - 22
publisher
Taylor & Francis
external identifiers
  • scopus:85029404919
  • pmid:28895428
ISSN
1745-3674
DOI
10.1080/17453674.2017.1371468
language
English
LU publication?
yes
id
db742c6a-d59a-41d9-8034-a3fb617b6139
date added to LUP
2017-10-09 10:13:44
date last changed
2018-04-10 03:00:19
@article{db742c6a-d59a-41d9-8034-a3fb617b6139,
  abstract     = {<p>Background and purpose — Impaction bone grafting (IBG) in revision hip surgery is an established method in restoring bone stock deficiencies. We hypothesized that local treatment of the morsellized allograft with a bisphosphonate in cemented revision would, in addition to increased bone density, also reduce the early migration of the cup as measured by radiostereometry (RSA). Patients and methods — 20 patients with aseptic cup loosening underwent revision using the IBG technique. The patients were randomized to either clodronate (10 patients) or saline (10 patients, control group) as local adjunct to the morsellized bone. The outcome was evaluated by dual-energy X-ray absorptiometry (DXA) during the first year regarding periacetabular bone density and with radiostereometric analysis (RSA) for the first 2 years regarding cup migration. Results — 2 patients were lost to follow-up: 9 patients remained in the clodronate and 9 in the control group. Less proximal migration was found in the clodronate group compared with the controls, measured both over time (mixed-models analysis, p = 0.02) as well as at the specified time points up to 2 years (0.22 mm and 0.59 mm respectively, p = 0.02). Both groups seemed to have stabilized at 1 year. We found similar bone mineral density measured by DXA, and similar RSA migration in the other directions. No cups were re-revised. Interpretation — Local treatment of the allograft bone with clodronate reduced early proximal migration of the revised cup but without any measurable difference in periacetabular bone density.</p>},
  author       = {Zampelis, Vasileios and Belfrage, Ola and Tägil, Magnus and Sundberg, Martin and Flivik, Gunnar},
  issn         = {1745-3674},
  keyword      = {bisphosphonate,bone grafting ,RCT},
  language     = {eng},
  number       = {1},
  pages        = {17--22},
  publisher    = {Taylor & Francis},
  series       = {Acta Orthopaedica},
  title        = {Decreased migration with locally administered bisphosphonate in cemented cup revisions using impaction bone grafting technique : A randomized, controlled study evaluated with RSA and DXA with a 2-year follow-up},
  url          = {http://dx.doi.org/10.1080/17453674.2017.1371468},
  volume       = {89},
  year         = {2018},
}