Statins, Bone Biology and Revision Arthroplasty: Review of Clinical and Experimental Evidence

Osteoarthritis is a painful, disabling condition which is increasing in prevalence as a result of an ageing population. With no recognised 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 the 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. Epidemiological and experimental research have demonstrated that there may be a biological and population-wide effect of statins in reducing the risk of revision arthroplasty. This work summarises the current breadth of evidence for this phenomenon including in vitro, in vivo and epidemiological research.