Denosumab prevents periprosthetic bone mineral density loss in the tibial metaphysis in total knee arthroplasty

Periprosthetic bone quality is one of the most important factors preventing early prosthesis migration and long-term failure. Although denosumab, which binds to the receptor activator of nuclear factor kappa-B ligand (RANKL), has been linked with periprosthetic bone mineral density (BMD), the effect...

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Bibliographic Details
Published in:The knee 2020-03, Vol.27 (2), p.580-586
Main Authors: Murahashi, Yasutaka, Teramoto, Atsushi, Jimbo, Shunsuke, Okada, Yohei, Kamiya, Tomoaki, Imamura, Rui, Takashima, Hiroyuki, Watanabe, Kota, Nagoya, Satoshi, Yamashita, Toshihiko
Format: Article
Language:English
Subjects:
Arthritis
Arthroplasty (knee)
Bisphosphonates
Bone density
Bone loss
Bone mineral density
Bone resorption
Bone surgery
Denosumab
Dual energy X-ray absorptiometry
Fractures
Immunotherapy
Joint replacement surgery
Joint surgery
Metabolism
Metaphysis
Monoclonal antibodies
Osteoarthritis
Osteoporosis
Patients
Periprosthetic bone
Prostheses
Studies
Surgery
Tibia
Total knee arthroplasty
TRANCE protein
Treatment
Variance analysis
Vitamin D
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Summary:Periprosthetic bone quality is one of the most important factors preventing early prosthesis migration and long-term failure. Although denosumab, which binds to the receptor activator of nuclear factor kappa-B ligand (RANKL), has been linked with periprosthetic bone mineral density (BMD), the effectiveness of denosumab against bone loss remains unclear. We hypothesized that denosumab treatment after total knee arthroplasty (TKA) could prevent periprosthetic bone resorption. In this prospective cohort study, 28 patients with primary knee osteoarthritis were divided into two groups: denosumab (denosumab and vitamin D) and control (vitamin D only) groups. All patients underwent TKA with the same implant model and received medication after surgery. We used dual-energy X-ray absorptiometry to measure periprosthetic BMD after TKA. In the control group, the BMD of the proximal medial tibia decreased drastically at 12 months after TKA (−19.7%). Denosumab treatment significantly preserved this BMD loss (0.7%). The linear regression analysis revealed that denosumab intervention had the highest significantly positive relationship with BMD. Our results indicate that denosumab treatment significantly reduces periprosthetic BMD loss, even at the early stages after TKA. This therapeutic strategy may facilitate early stable fixation of the prosthesis which, in turn, may help to prevent early implant migration and reduce the need for revision surgery.
ISSN:0968-0160
1873-5800
DOI:10.1016/j.knee.2019.12.010