Osteoarthritis is a painful, disabling condition which is increasing in prevalence as a result of an ageing population. With no recognized disease-limiting
therapeutics,
arthroplasty of the hip and knee is the most common and effective treatment for lower limb
osteoarthritis, however lower limb
arthroplasty has a finite life-span and a proportion of patients will require revision
arthroplasty. With increasing life expectancy and an increasing proportion of younger (<65 years) patients undergoing
arthroplasty, the demand for revision
arthroplasty after implant failure is also set to increase.
Statins are
cholesterol-modulating drugs widely used for cardiovascular risk reduction which have been noted to have pleiotropic effects including potentially influencing
arthroplasty survival. In vitro studies have demonstrated pleiotropic effects in human bone cells, including enhancement of osteoblastogenesis following
simvastatin exposure, and in vivo studies have demonstrated that intraperitoneal
simvastatin can increase peri-implant bone growth in rats following
titanium tibial implant insertion. There is evidence that
statins may also influence osseointegration, enhancing bone growth at the
bone-implant interface, subsequently improving the functional survival of implants. Data from the Danish Hip
Arthroplasty Registry and the Clinical Practice Research Datalink in the UK suggest a reduction in the risk of lower limb revision
arthroplasty in
statin ever-users versus never-users, and a time-dependent effect of
statins in reducing the risk of revision. In this article we review the clinical and experimental evidence linking
statins and risk of revision
arthroplasty.