Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK GREMPAL Research Group, IDIAP Jordi Gol Primary Care Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain URFOA, Institut Municipal d'Investigacions Mèdiques (IMIM), Parc de Salut Mar, Barcelona, Spain RETICEF (Red Temática de Investigación Cooperativa en Envejecimiento y Fragilidad), Instituto Carlos III, Madrid, Spain.
Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
Ann Rheum Dis. 2015 Mar;74(3):557-63. doi: 10.1136/annrheumdis-2013-204043. Epub 2014 Jan 22.
Osteolysis and subsequent prosthesis loosening is the most common cause for revision following total knee arthroplasty (TKA) or total hip arthroplasty (THA). Hormone replacement therapy (HRT) could reduce osteolysis through its antiresorptive effects. We studied whether HRT use is associated with reduced revision rates in a community-based cohort of women undergoing TKA or THA for osteoarthritis.
Female participants in the General Practice Research Database undergoing a primary TKA or THA from 1986 to 2006 were included. We excluded patients aged <40 years at the date of primary, and those with a history of previous hip fracture or rheumatoid arthritis. Women with at least 6 months of HRT were identified as HRT users. We further explored the associations among HRT use of ≥12 months, adherence (medication possession ratio) and cumulative use and revision risk. Cox models were fitted to model implant survival in years. Propensity score matching was used to control for confounding.
We matched 2700 HRT users to 8100 non-users, observed for a median (IQR) of 3.3 (1.5-6.1) years after TKA/THA. HR for HRT ≥6 months was 0.62 (95% CI 0.41 to 0.94), whereas HR for ≥12 months was 0.48 (0.29 to 0.78). Higher adherence and therapy duration were associated with further reductions in revision rates. Preoperative HRT appeared unrelated to implant survival.
HRT use is associated with an almost 40% reduction in revision rates after a TKA/THA. These findings require replication in external cohorts and experimental studies.
骨溶解和随后的假体松动是全膝关节置换术（TKA）或全髋关节置换术（THA）后翻修的最常见原因。激素替代疗法（HRT）可以通过其抗吸收作用减少骨溶解。我们研究了 HRT 的使用是否与接受 TKA 或 THA 治疗骨关节炎的女性患者的翻修率降低有关。
本研究纳入了 1986 年至 2006 年期间在普通实践研究数据库中接受初次 TKA 或 THA 的女性参与者。我们排除了初次就诊时年龄<40 岁的患者，以及有既往髋部骨折或类风湿关节炎病史的患者。至少使用 HRT 6 个月的患者被确定为 HRT 使用者。我们进一步探讨了 HRT 使用≥12 个月、依从性（药物占有比）和累计使用与翻修风险之间的关系。使用 Cox 模型来建立植入物在年数上的生存模型。使用倾向评分匹配来控制混杂因素。
我们匹配了 2700 名 HRT 使用者和 8100 名非使用者，在 TKA/THA 后中位（IQR）随访 3.3（1.5-6.1）年。HRT 使用≥6 个月的 HR 为 0.62（95%CI 0.41-0.94），而 HRT 使用≥12 个月的 HR 为 0.48（0.29-0.78）。较高的依从性和治疗持续时间与进一步降低翻修率相关。术前 HRT 似乎与植入物的存活率无关。
TKA/THA 后 HRT 的使用与翻修率降低近 40%相关。这些发现需要在外部队列和实验研究中得到复制。
