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Postoperative Bisphosphonates Use is Associated with Reduced Adverse Outcomes After Primary Total Joint Arthroplasty of Hip and Knee: A Nationwide Population-Based Cohort Study

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Abstract

Bisphosphonates have been associated with a decreased risk of revision surgery after total joint arthroplasty of the hip or knee (TJA) because of their effects on decreased periprosthetic bone loss and prosthetic migration. However, the results in the early literature are inconsistent, and the influence of bisphosphonates on associated complications and subsequent TJA remains unknown. This study investigated the association between the use of bisphosphonates and the risk of adverse outcomes after primary TJA. This matched cohort study utilized the National Health Insurance Research Database in Taiwan to identify patients who underwent primary TJA over a 15-year period (January 2000–December 2015 inclusive). Study participants were further categorized into two groups, bisphosphonate users and nonusers, using propensity score matching. The Kaplan–Meier curve analysis and adjusted hazard ratios (aHRs) of revision surgery, adverse outcomes of primary surgery and subsequent TJA were calculated using Cox regression analysis. This study analyzed data from 6485 patients who underwent total hip arthroplasty (THA) and 20,920 patients who underwent total knee arthroplasty (TKA). The risk of revision hip and knee arthroplasty was significantly lower in the bisphosphonate users than in the nonusers (aHR, 0.54 and 0.53, respectively). Furthermore, the risk of a subsequent total joint arthroplasty, adverse events and all-cause mortality were also significantly reduced in the bisphosphonate users. This study, involving a large cohort of patients who underwent primary arthroplasties, revealed that bisphosphonate treatment may potentially reduce the risk of revision surgery and associated adverse outcomes. Furthermore, the use of bisphosphonates after TJA is also associated with a reduced need for subsequent arthroplasty.

Research Registration Unique Identifying Number (UIN): ClinicalTrials.gov Identifier—NCT05623540 (https://clinicaltrials.gov/show/NCT05623540).

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Data Availability

The data that support the findings of this study are available from National Health Insurance Research Database, which belongs to Health and Welfare Data Science Center, Ministry of Health and Welfare, Taiwan. Restrictions apply to the availability of these data, which were used under license for this study. Data are only available with the permission of National Health Insurance Research Database.

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Acknowledgements

We appreciate the Health and Welfare Data Science Center, Ministry of Health and Welfare (HWDC, MOHW), Taiwan, for providing the National Health Insurance Research Database (NHIRD).

Funding

This study was supported by the Tri-Service General Hospital Research Foundation (Grant Number: TSGH-D-110103).

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Authors and Affiliations

  1. Department of Orthopedics, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Chenggong Rd., Neihu Dist., Taipei City, 11472, Taiwan

    Jen-Ta Shih, Pei-Hung Shen, Tsu-Te Yeh, Chia-Chun Wu, Ru-Yu Pan & Sheng-Hao Wang

  2. Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei City, Taiwan

    Jen-Ta Shih

  3. Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA

    Timothy L. Tan

  4. School of Public Health, National Defense Medical Center, Taipei City, Taiwan

    Wu-Chien Chien & Chi-Hsiang Chung

  5. Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan

    Wu-Chien Chien & Chi-Hsiang Chung

  6. Taiwanese Injury Prevention and Safety Promotion Association, Taipei City, Taiwan

    Wu-Chien Chien & Chi-Hsiang Chung

  7. Graduate Institute of Life Sciences, National Defense Medical Center, Taipei City, Taiwan

    Wu-Chien Chien

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Contributions

S-HW: Conceptualization, Supervision; J-TS: Writing—Original draft preparation; TLT: Writing—Reviewing and Editing; P-HS: Methodology; T-TY: Visualization, Investigation; C-CW: Project administration; R-YP: Validation; W-CC: Resources, Data curation; C-HC: Software, Formal analysis.

Corresponding author

Correspondence to Sheng-Hao Wang.

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Conflict of interest

Jen-Ta Shih, Timothy L Tan, Pei-Hung Shen, Tsu-Te Yeh, Chia-Chun Wu, Ru-Yu Pan, Wu-Chien Chien, Chi-Hsiang Chung, Sheng-Hao Wang have no relevant financial or non-financial interests to disclose.

Ethical Approval

The study protocol was approved by the Institutional Review Board of Tri-Service General Hospital, National Defense Medical Center (Approval No.: B-111-05). All procedures were performed in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Human and Animal Rights and Informed Consent

This database study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The informed conset was waived because this study invovled no more than minimal riskand used de-idetification data. The IRB of National Defense Medical Center approved this study (approval No. B-111-05).

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Shih, JT., Tan, T.L., Shen, PH. et al. Postoperative Bisphosphonates Use is Associated with Reduced Adverse Outcomes After Primary Total Joint Arthroplasty of Hip and Knee: A Nationwide Population-Based Cohort Study. Calcif Tissue Int 114, 451–460 (2024). https://doi.org/10.1007/s00223-024-01192-6

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