Department of Orthopedics, Aarhus University Hospital, Aarhus N, Denmark.
J Bone Joint Surg Am. 2010 May;92(5):1063-72. doi: 10.2106/JBJS.H.01805.
Statins have been associated with beneficial effects on bone metabolism and inflammation in both experimental and clinical studies. The association between statin use and the risk of revision after primary total hip arthroplasty has not been examined.
We identified 2349 patients from the Danish Hip Arthroplasty Registry who underwent revision of a primary total hip replacement in the period from 1996 to 2005 and matched them, using propensity score matching, with 2349 controls with a total hip replacement who had not had a revision. Using conditional logistic regression, we estimated the relative risk of revision due to all causes and due to specific causes according to postoperative statin use.
The ten-year cumulative implant revision rate in the underlying cohort of 57,581 total hip arthroplasties from the registry was 8.9% (95% confidence interval, 8.4% to 9.4%). Postoperative statin use was associated with an adjusted relative risk of revision of 0.34 (95% confidence interval, 0.28 to 0.41) compared with no use of statin. Statin use was associated with a reduced risk of revision due to deep infection, aseptic loosening, dislocation, and periprosthetic fracture. No difference in the risk of revision due to pain or implant failure was found between statin users and nonusers.
The use of statins was associated with a substantially lower revision risk following primary total hip arthroplasty. Statins, however, should not be prescribed to healthy patients undergoing total hip arthroplasty in order to improve the longevity of the replacement until further studies have confirmed our finding and the mechanisms for this association have been clarified.
在实验和临床研究中，他汀类药物已被证明对骨代谢和炎症具有有益作用。然而，他汀类药物的使用与初次全髋关节置换术后翻修风险之间的关系尚未被研究。
我们从丹麦髋关节置换登记处确定了 2349 名患者，他们在 1996 年至 2005 年期间接受了初次全髋关节置换的翻修手术，并使用倾向评分匹配法，与 2349 名未接受翻修的初次全髋关节置换术的对照组相匹配。使用条件逻辑回归，我们根据术后他汀类药物的使用情况，估计了所有原因和特定原因导致翻修的相对风险。
在登记处的 57581 例全髋关节置换术的基础队列中，十年累积植入物翻修率为 8.9%（95%置信区间，8.4%至 9.4%）。与未使用他汀类药物相比，术后使用他汀类药物与调整后的翻修相对风险降低 0.34（95%置信区间，0.28 至 0.41）相关。他汀类药物的使用与降低深部感染、无菌性松动、脱位和假体周围骨折的翻修风险相关。在使用他汀类药物和未使用他汀类药物的患者之间，翻修原因导致的疼痛或植入物失败的风险没有差异。
在初次全髋关节置换术后，使用他汀类药物与翻修风险显著降低相关。然而，在进一步的研究证实我们的发现并阐明这种关联的机制之前，不应该为接受全髋关节置换术的健康患者开具他汀类药物，以提高置换的使用寿命。
