Lower Total Knee Arthroplasty Revision Risk Associated With Bisphosphonate Use, Even in Patients With Normal Bone Density

Robert S. Namba, Maria C.S. Inacio, T. Craig Cheetham, Richard M. Dell, Elizabeth W. Paxton, Monti X. Khatod

Research output: Contribution to journalArticlepeer-review

28 Citations (Scopus)


Background: Bisphosphonates (BPs) are associated with lower total knee arthroplasty (TKA) revision risk, but the effect of bone mineral density has not been evaluated. Methods: A cohort of 34,116 primary TKA patients was evaluated with revision surgery and periprosthetic fractures as end points. BP usage was the exposure of interest. Bone quality (normal, osteopenia, and osteoporosis) and patient age (<. 65 vs ≥. 65 years) were evaluated as effect modifiers of risk estimates. Results: Of the patients, 19.6% were BP users. In BP users, 0.5% underwent an aseptic revision; and 0.6%, a periprosthetic fracture. In non-BP users, 1.6% underwent aseptic revision; and 0.1%, a periprosthetic fracture. Conclusion: Bisphosphonate use was associated with lower risk of revision in all bone quality categories in those older than 65 years. The risk of periprosthetic fractures was higher for patients on BP.

Original languageEnglish
Pages (from-to)537-541
Number of pages5
JournalJournal of Arthroplasty
Issue number2
Publication statusPublished or Issued - 1 Feb 2016
Externally publishedYes


  • Bisphosphonates
  • Bone density
  • Revision
  • Total knee

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this