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Medicine

Osteoarthritis patients set to benefit from new evidence for increasing the lifetime of joint implants

Published: 7 December 2011

Patients who have undergone knee or hip replacement surgery could potentially double the life of their implant by taking readily available osteoporosis drugs called bisphosphonates.

Results from a study led by Professor Nigel Arden which was funded by a National Institute for Health Research (NIHR) Programme Grant for Applied Research, are published today in the British Medical Journal.

The trial took place at the NIHR Musculoskeletal Biomedical Research Unit (BRU) at the Nuffield Orthopaedic Centre NHS Trust and the University of Oxford in collaboration with researchers at the Medical Research Council (MRC) Lifecourse Epidemiology Unit at the University of Southampton.

This study has shown that bisphosphonate use in patients who have undergone joint replacements is related to an almost twofold increase in implant survival time.

Osteoarthritis is the most common form of arthritis in the western world and affects at least eight million people in the UK. Total joint replacement is the most effective therapy for patients suffering severe osteoarthritis and around 160,000 hip and knee replacement procedures took place last year.

However, joint replacements only last 10-15 years and almost 13,000 of these procedures were 'revision' surgeries to replace a patient's original implant. These revision surgeries are expensive (costing around £34,000 compared to £7,000 for the initial joint replacement surgery) and the outcome is less effective than the original hip or knee replacement.

The most common cause for revision surgery is implant loosening, which occurs when the bone surrounding the implant breaks down. Bisphosphonates prevent this breakdown by impairing the function of cells in the body called osteoclasts, which digest bone.

Using the General Practice Research Database (GPRD) - the world's largest computerised database of anonymous primary care medical records - the researchers identified 1,912 bisphosphonate users out of 41,995 patients who had undergone primary hip or knee replacement. On analysing their data, they found that only 0.93 per cent of bisphosphonate users required revision surgery after five years compared to 1.96 per cent of non-users, and that the average time before revision surgery was required in bisphosphonate users was almost double that of non-users.

Study lead, Professor Nigel Arden, senior researcher at the NIHR Musculoskeletal BRU said:"The prevalence of osteoarthritis is increasing significantly and with an ageing population and rising obesity, the need for joint replacements will increase dramatically over the next ten years.

"Historically, research in this area has focused on the joint replacements themselves and the surgical techniques used to implant them. This is the first time that a study on implant revision has focused on the patient and if this result is confirmed in clinical trials, bisphosphonate use would be a simple cost-effective intervention to improve the outcome of this increasingly common operation.

"Based on this, more research should focus on the patient and the quality and metabolism of their bones."

Professor Cyrus Cooper, Director of the MRC Lifecourse Epidemiology Unit at the University of Southampton said:"Joint replacements can offer a new lease of life for patients plagued by painful and debilitating osteoarthritis. But failure of these replacement joints is a huge problem that can lead to further patient discomfort and expensive revision surgeries.

"This study opens up an entirely new avenue for reducing replacement joint failure by using a relatively inexpensive class of drugs that is already licensed for use in a wide range of diseases. It also demonstrates how marrying large national patient databases such as GPRD with active medical research can speed up translation of scientific discoveries to real improvements in human health."

The researchers are now taking steps to gather more evidence to support the link between bisphosphonate use and increased implant survival in a full clinical trial.

Health Secretary Andrew Lansley, said:"Thanks to Government funded research, we now know that patients with hip or knee implants can double the life of their implant by taking osteoarthritis drugs.

"This is great news for patients as it means fewer painful operations. It is also great for the NHS as it will save money and show it off to be a world class health service where the latest innovations benefit patients." 

Professor Dame Sally C. Davies, Chief Medical Officer and Chief Scientific Adviser at the Department of Health said:"I welcome the findings from this important study.

"With such a high incidence of knee and hip replacement surgery, the possibility that the life of joint implants could be lengthened and reduce the number of complex revision surgeries means that these results have the potential to make significant improvements to the lives of many NHS patients."

Notes for editors

The University of Southampton is a leading UK teaching and research institution with a global reputation for leading-edge research and scholarship across a wide range of subjects in engineering, science, social sciences, health and humanities.

With over 23,000 students, around 5000 staff, and an annual turnover well in excess of £435 million, the University of Southampton is acknowledged as one of the country's top institutions for engineering, computer science and medicine. We combine academic excellence with an innovative and entrepreneurial approach to research, supporting a culture that engages and challenges students and staff in their pursuit of learning.

The University is also home to a number of world-leading research centres including the Institute of Sound and Vibration Research, the Optoelectronics Research Centre, the Web Science Trust and Doctoral training Centre, the Centre for the Developmental Origins of Health and Disease, the Southampton Statistical Sciences Research Institute and is a partner of the National Oceanography Centre at the Southampton waterfront campus.

www.soton.ac.uk

Programme Grants for Applied Research are awards made by the National Institute for Health Research (NIHR) to fund high quality research that address areas of priority or need for the NHS. Programme Grants award up to £2 million over three to five years to the best applied research teams from the NHS and academia working together to provide evidence to improve health outcomes in England through the promotion of health, the prevention of ill health and optimal disease management (including safety and quality). Programme Grants typically fund programmes of interrelated, high-quality research projects and associated infrastructure that are designed to deliver findings that can be directly and practically applied in the relatively near future, for the benefit of patients and the NHS. www.pgfar.nihr.ac.uk

The National Institute for Health Research (NIHR) provides the framework through which the research staff and research infrastructure of the NHS in England is positioned, maintained and managed as a national research facility. The NIHR provides the NHS with the support and infrastructure it needs to conduct first-class research funded by the Government and its partners alongside high-quality patient care, education and training. Its aim is to support outstanding individuals (both leaders and collaborators), working in world-class facilities (both NHS and university), conducting leading-edge research focused on the needs of patients. www.nihr.ac.uk

For almost 100 years the Medical Research Council has improved the health of people in the UK and around the world by supporting the highest quality science. The MRC invests in world-class scientists. It has produced 29 Nobel Prize winners and sustains a flourishing environment for internationally recognised research. The MRC focuses on making an impact and provides the financial muscle and scientific expertise behind medical breakthroughs, including one of the first antibiotics penicillin, the structure of DNA and the lethal link between smoking and cancer. Today MRC funded scientists tackle research into the major health challenges of the 21st century. www.mrc.ac.uk

The University of Oxford's Medical Sciences Division is one of the largest biomedical research centres in Europe, with over 2,500 people involved in research and more than 2,800 students. It brings in around two-thirds of the university's external research income. Listed by itself, that would make it the fifth largest UK university in terms of research grants and contracts. A major strength of Oxford medicine is its long-standing network of clinical research units in Asia and Africa, enabling world-leading research on malaria, TB, HIV/AIDS and flu. Oxford is also renowned for its large-scale studies into the causes and treatment of cancer, heart disease, diabetes and other common conditions.

For further information contact:

Becky Attwood , Media Relations, University of Southampton, Tel: 023 8059 5457, email: r.attwood@soton.ac.uk

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