Peer-reviewed veterinary case report
Dog knee surgery recovery - does antiresorptive therapy help?
By Huffman AB et al.·2026·Marshall University, United States·View original on Europe PMC →
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Original publication title: Antiresorptive Therapy and Revision Risk After Primary Total Knee Arthroplasty: A Systematic Review and Meta-Analysis.
Plain-English summary
This study looked at whether certain medications, called bisphosphonates and denosumab, can help reduce the need for additional surgeries after a total knee replacement. Researchers reviewed many studies and found that using bisphosphonates was linked to a lower chance of needing another surgery, but the evidence was not very strong and varied a lot between studies. They did not find significant benefits for preventing other issues like loosening of the implant, fractures around the joint, or maintaining bone density after a year. Denosumab showed some promise in reducing early movement of the implant, but there were no long-term survival benefits reported. Overall, while bisphosphonate therapy may help reduce the need for further surgeries, the evidence is not very reliable.
Abstract
<h4>Background</h4>This systematic review evaluates whether the use of bisphosphonates or denosumab influences the rate of revision and aseptic loosening after primary total knee arthroplasty (TKA). Additionally, the effects of antiresorptive therapy on periprosthetic fracture risk, bone mineral density (BMD) loss, and migration after TKA were evaluated, along with the potential adverse effects associated with these therapies.<h4>Methods</h4>A systematic review and meta-analysis were conducted using PubMed, Cochrane Library databases, and gray literature between January 2009 and July 2025 to identify studies evaluating bisphosphonate or denosumab use after primary TKA.<h4>Results</h4>After screening 253 results, 12 studies encompassing 426,920 patients met the inclusion criteria, with 4 studies eligible for meta-analysis. There were 7 randomized controlled trials) and 5 prospective/retrospective cohort studies; meta-analytic estimates were derived exclusively from registry-based cohorts. Bisphosphonate use was associated with a significantly lower rate of all-cause revision (1.37% vs 2.71%; <i>P</i> = .0046, confidence interval: 0.255-0.779, odds ratio = 0.446), although heterogeneity was substantial (<i>P</i> < .0001, <i>I</i> <sup><i>2</i></sup> = 95.5%). No significant protective effect was observed for aseptic loosening, periprosthetic fracture, or BMD beyond 12 months. In assessments of component maximum total point motion, denosumab demonstrated reduced early implant migration (<i>P</i> = .01 and <i>P</i> = .048), with no survivorship outcomes reported.<h4>Conclusions</h4>Bisphosphonate therapy after TKA is associated with a lower risk of all-cause revision; however, the certainty of evidence is low, and the findings are limited by substantial heterogeneity. No consistent benefit was observed for aseptic loosening, periprosthetic fracture, or long-term BMD preservation.
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Search related cases →Original publication on Europe PMC: https://europepmc.org/article/MED/41884750