Law Tsun Yee, Kurowicki Jennifer, Rosas Samuel, Sabeh Karim, Summers Spencer, Hubbard Zachary, Roche Martin
Holy Cross Orthopedic Institute, Oakland Park, Florida.
Seton Hall University, School of Health and Medical Sciences, Department of Orthopaedics, 400 S Orange Ave, South Orange, NJ 07079.
J Long Term Eff Med Implants. 2018;28(2):125-130. doi: 10.1615/JLongTermEffMedImplants.2018027401.
As an increasing number of states begin to legalize marijuana for either medical or recreational use, it is important to determine its effects on joint arthroplasty. The purpose of this study is to determine the impact of cannabis use on total knee arthroplasty (TKA) revision incidence, revision causes, and time to revision by analyzing the Medicare database between 2005 and 2014. A retrospective review of the Medicare database for TKA, revision TKA, and causes was performed utilizing Current Procedural Terminology (CPT) and International Classification of Disease ninth revision codes (ICD-9). Patients who underwent TKA were cross-referenced for a history of cannabis use by querying ICD-9 codes 304.30-32 and 305.20-22. The resulting group was then longitudinally tracked postoperatively for revision TKA. Cause for revision, time to revision, and gender were also investigated. Our analysis returned 2,718,023 TKAs and 247,112 (9.1%) revisions between 2005 and 2014. Cannabis use was prevalent in 18,875 (0.7%) of TKA patients with 2,419 (12.8%) revisions within the cannabis cohort. Revision incidence was significantly greater in patients who use cannabis (p < 0.001). Time to revision was also significantly decreased in patients who used cannabis, with increased 30- and 90-day revision incidence compared to the noncannabis group (P < 0.001). Infection was the most common cause of revision in both groups (33.5% nonusers versus 36.6% cannabis users).Cannabis use may result in decreasing implant survivorship and increasing the risk for revision within the 90-day global period compared to noncannabis users following primary TKA.
随着越来越多的州开始将大麻用于医疗或娱乐用途合法化，确定其对关节置换术的影响变得很重要。本研究的目的是通过分析2005年至2014年的医疗保险数据库，确定大麻使用对全膝关节置换术（TKA）翻修发生率、翻修原因和翻修时间的影响。利用当前程序术语（CPT）和国际疾病分类第九版代码（ICD-9）对医疗保险数据库中TKA、翻修TKA及原因进行了回顾性审查。通过查询ICD-9代码304.30-32和305.20-22，对接受TKA的患者进行大麻使用史的交叉对照。然后对结果组进行术后纵向跟踪以观察TKA翻修情况。还调查了翻修原因、翻修时间和性别。我们的分析显示，2005年至2014年间有2718023例TKA，其中247112例（9.1%）进行了翻修。在18875例（0.7%）TKA患者中普遍存在大麻使用情况，大麻使用队列中有2419例（12.8%）进行了翻修。使用大麻的患者翻修发生率显著更高（p<0.001）。使用大麻的患者翻修时间也显著缩短，与非大麻使用组相比，30天和90天翻修发生率增加（P<0.001）。感染是两组中最常见的翻修原因（非使用者为33.5%，大麻使用者为36.6%）。与初次TKA后的非大麻使用者相比，大麻使用可能导致植入物生存率降低，并增加90天全球范围内的翻修风险。
