Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, UK.
BMJ. 2011 Dec 6;343:d7222. doi: 10.1136/bmj.d7222.
To test whether bisphosphonate use is related to improved implant survival after total arthroplasty of the knee or hip.
Population based retrospective cohort study.
Primary care data from the United Kingdom.
All patients undergoing primary total arthroplasty of the knee (n = 18,726) or hip (n = 23,269) in 1986-2006 within the United Kingdom's General Practice Research Database. We excluded patients with a history of hip fracture before surgery or rheumatoid arthritis, and individuals younger than 40 years at surgery.
Bisphosphonate users were classified as patients with at least six prescriptions of bisphosphonates or at least six months of prescribed bisphosphonate treatment with more than 80% adherence before revision surgery.
Revision arthroplasties occurring after surgery, identified by READ and OXMIS codes. Parametric survival models were used to determine effects on implant survival with propensity score adjustment to account for confounding by indication. Results Of 41 995 patients undergoing primary hip or knee arthroplasty, we identified 1912 bisphosphonate users, who had a lower rate of revision at five years than non-users (0.93% (95% confidence interval 0.52% to 1.68%) v 1.96% (1.80% to 2.14%)). Implant survival was significantly longer in bisphosphonate users than in non-users in propensity adjusted models (hazard ratio 0.54 (0.29 to 0.99); P = 0.047) and had an almost twofold increase in time to revision after hip or knee arthroplasty (time ratio 1.96 (1.01 to 3.82)). Assuming 2% failure over five years, we estimated that the number to treat to avoid one revision was 107 for oral bisphosphonates. Conclusions In patients undergoing lower limb arthroplasty, bisphosphonate use was associated with an almost twofold increase in implant survival time. These findings require replication and testing in experimental studies for confirmation.
检验双膦酸盐的使用是否与膝关节或髋关节全关节置换术后植入物的存活率提高有关。
基于人群的回顾性队列研究。
英国的初级保健数据。
1986 年至 2006 年期间，在英国全科医生研究数据库中接受膝关节（n=18726）或髋关节（n=23269）初次全关节置换术的所有患者。我们排除了术前有髋部骨折史或类风湿关节炎的患者，以及手术时年龄小于 40 岁的患者。
双膦酸盐使用者被定义为至少接受过 6 次双膦酸盐处方或至少接受过 6 个月的规定双膦酸盐治疗，且治疗依从性超过 80%的患者。
通过 READ 和 OXMIS 代码确定术后发生的关节翻修。使用参数生存模型来确定对植入物存活率的影响，并采用倾向评分调整来校正指示性混杂因素。
在接受初次髋关节或膝关节置换术的 41995 例患者中，我们确定了 1912 例双膦酸盐使用者，他们在五年时的翻修率低于非使用者（0.93%（95%置信区间 0.52%至 1.68%）比 1.96%（1.80%至 2.14%））。在倾向调整模型中，双膦酸盐使用者的植入物存活率明显长于非使用者（风险比 0.54（0.29 至 0.99）；P=0.047），并且髋关节或膝关节置换术后翻修的时间明显延长（时间比 1.96（1.01 至 3.82））。假设五年内失败率为 2%，我们估计，为避免一次翻修，需要治疗的人数为 107 例口服双膦酸盐。
在接受下肢关节置换术的患者中，双膦酸盐的使用与植入物存活率时间几乎增加了一倍有关。这些发现需要在实验研究中进行复制和验证。
