Varady Nathan H, Abraham Paul, Kucharik Michael P, Eberlin Christopher T, Freccero David, Smith Eric L, Martin Scott D
Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School.
Department of Orthopaedic Surgery, Boston Medical Center.
Arthrosc Sports Med Rehabil. 2021 Aug 20;3(5):e1407-e1412. doi: 10.1016/j.asmr.2021.07.003. eCollection 2021 Oct.
To investigate the association between intrauterine device (IUD) use and hip pain, orthopaedic visits for hip pain, and arthroscopic hip surgery.
This was a retrospective cohort study of patients aged 18-44 years old using either IUDs or subdermal implants for contraception in a large commercial claims database (MarketScan) from 2012 to 2015. All patients had at least 12 months of continuous enrollment both before and after contraceptive placement. Patients with a history of hip pain or surgery were excluded. The primary outcome was new hip pain. Secondary outcomes included visiting an orthopaedic or sports medicine provider for a hip complaint, intra-articular hip injection, and arthroscopic hip surgery. Outcomes were analyzed with Cox proportional-hazard models.
We identified a total of 242,383 patients, including 216,541 (89.3%) with IUDs and 25,842 (10.7%) with subdermal contraceptive implants. In time-to-event analysis, IUDs (vs implants) were not associated with increased risk of new hip pain diagnoses (hazard ratio [HR] 0.95, 95% confidence interval [CI] 0.87-1.03, = .21). In contrast, both age ( < .001) and region ( < .001) were associated with increased risk of new hip pain. Similar results were seen for the secondary outcomes, including risk of orthopaedic visits for hip complaints (HR 1.06, 95% CI 0.83-1.35, = .63), intra-articular injections of the hip (HR 0.94, 95% CI 0.63-1.41, = .77), and hip arthroscopy procedures (HR 1.13, 95% CI 0.53-2.40, = .75).
In this study, we found no evidence that IUDs were associated with hip pain or surgery.
Level III, retrospective cohort.
探讨宫内节育器（IUD）的使用与髋部疼痛、因髋部疼痛进行的骨科就诊以及髋关节镜手术之间的关联。
这是一项回顾性队列研究，研究对象为2012年至2015年在一个大型商业索赔数据库（MarketScan）中使用IUD或皮下植入物进行避孕的18至44岁患者。所有患者在避孕措施放置前后均至少连续登记12个月。有髋部疼痛或手术史的患者被排除。主要结局是新发髋部疼痛。次要结局包括因髋部问题就诊于骨科或运动医学医生、髋关节内注射以及髋关节镜手术。采用Cox比例风险模型分析结局。
我们共识别出242,383名患者，其中216,541名（89.3%）使用IUD，25,842名（10.7%）使用皮下避孕植入物。在事件发生时间分析中，IUD（与植入物相比）与新发髋部疼痛诊断风险增加无关（风险比[HR]0.95，95%置信区间[CI]0.87 - 1.03，P = 0.21）。相比之下，年龄（P < 0.001）和地区（P < 0.001）与新发髋部疼痛风险增加相关。次要结局的结果相似，包括因髋部问题进行骨科就诊的风险（HR 1.06，95% CI 0.83 - 1.35，P = 0.63）、髋关节内注射（HR 0.94，95% CI 0.63 - 1.41，P = 0.77）以及髋关节镜手术（HR 1.13，95% CI 0.53 - 2.40，P = 0.75）。
在本研究中，我们未发现证据表明IUD与髋部疼痛或手术有关。
三级，回顾性队列研究。
