Bisphosphonate use in patients undergoing total knee arthroplasty reduces overall and aseptic revisions and periprosthetic bone mineral density loss: A systematic review from the FP‐UCBM Knee Study Group
Bibliographic record
Abstract
PURPOSE: Bisphosphonates (BPs), widely used for osteoporosis management, have garnered attention in the context of total knee arthroplasty (TKA) for their potential to preserve periprosthetic bone mineral density (BMD) and mitigate risks such as aseptic loosening, periprosthetic fractures, and implant failure. This study systematically reviewed the current literature on the topic, hypothesising that BP therapy reduces the risk of postoperative adverse outcomes in patients undergoing TKA. METHODS: A systematic literature search was conducted on 1 December 2024 using PubMed, Cochrane Library, Scopus and Google Scholar. Inclusion criteria were: English-language randomised controlled trials (RCTs), comparative prospective or retrospective studies, and studies evaluating postoperative outcomes (including all-cause and aseptic revisions, periprosthetic BMD loss, periprosthetic fractures and implant migration) in patients undergoing TKA who received BP treatment. Exclusion criteria were: computational studies; case reports; studies focusing uniquely on the surgical technique; studies reporting only cumulative data for total joint arthroplasty. RESULTS: A total of 14 studies (480,294 patients) were included. Six studies focused exclusively on osteoporotic patients, six on non-osteoporotic patients and two on a mixed BMD population. The rate of all-cause and aseptic revisions was 1.5% and 1.1% respectively for BP users, and 2.3% and 2.5%, for non-BP users. Mean pre-/post-operative variation in BMD was -0.04 for BP users and -0.2 for non-BP users. The risk of bias was graded as low using the ROB 2 tool for RCTs and the Newcastle-Ottawa Scale for observational studies. CONCLUSION: Bisphosphonate use in patients undergoing total knee arthroplasty is associated with lower rates of overall and aseptic revisions, reduced periprosthetic BMD loss, and inconclusive effects on periprosthetic fractures and implant migration. LEVEL OF EVIDENCE: Level IV.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.018 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.008 | 0.009 |
| Bibliometrics | 0.008 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".