Deere Kevin, Matharu Gulraj S, Ben-Shlomo Yoav, Wilkinson J Mark, Blom Ashley W, Sayers Adrian, Whitehouse Michael R
Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Bristol, UK.
Department of Population Health Sciences, University of Bristol, Bristol, UK.
Bone Joint J. 2022 Jan 12:1-9. doi: 10.1302/0301-620X.104B.BJJ-2021-0397.R1.
A recent report from France suggested an association between the use of cobalt-chrome femoral heads in total hip arthroplasties (THAs) and an increased risk of dilated cardiomyopathy and heart failure. Cobalt-chrome is a commonly used material in orthopaedic implants. If the reported association is causal, the consequences would be significant given the millions of joint replacements and other orthopaedic procedures in which cobalt-chrome is used annually. We examined whether cobalt-chrome-containing THAs were associated with an increased risk of all-cause mortality, heart outcomes, cancer, and neurodegenerative disorders in a large national database.
Data from the National Joint Registry was linked to NHS English hospital inpatient episodes for 374,359 primary THAs with up to 14.5 years follow-up. We excluded any patients with bilateral THAs, knee replacements, indications other than osteoarthritis, aged under 55 years, and diagnosis of one or more outcome of interest before THA. Implants were grouped as either containing cobalt-chrome or not containing cobalt-chrome. The association between implant construct and the risk of all-cause mortality and incident heart failure, cancer, and neurodegenerative disorders was examined.
There were 158,677 individuals (42.4%) with an implant containing cobalt-chrome. There were 47,963 deaths, 27,332 heart outcomes, 35,720 cancers, and 22,025 neurodegenerative disorders. There was no evidence of an association that patients with cobalt-chrome implants had higher rates of any of the outcomes.
Cobalt-chrome-containing THAs did not have an increased risk of all-cause mortality, or clinically meaningful heart outcomes, cancer or neurodegenerative disorders into the second decade post-implantation. Our findings will help reassure clinicians and the increasing number of patients receiving primary THA worldwide that the use of cobalt-chrome containing implants is not associated with significant adverse systemic effects.
法国最近的一份报告表明，在全髋关节置换术（THA）中使用钴铬合金股骨头与扩张型心肌病和心力衰竭风险增加之间存在关联。钴铬合金是骨科植入物中常用的材料。如果所报告的关联是因果关系，鉴于每年有数百万例使用钴铬合金的关节置换和其他骨科手术，其后果将是严重的。我们在一个大型国家数据库中研究了含钴铬合金的全髋关节置换术是否与全因死亡率、心脏疾病、癌症和神经退行性疾病风险增加有关。
将国家关节注册中心的数据与英国国民健康服务体系（NHS）英格兰地区医院的住院病历相链接，纳入374359例初次全髋关节置换术患者，随访时间长达14.5年。我们排除了双侧全髋关节置换术患者、膝关节置换术患者、骨关节炎以外适应症患者、年龄在55岁以下患者以及在全髋关节置换术前被诊断患有一种或多种感兴趣结局的患者。植入物被分为含钴铬合金或不含钴铬合金两类。研究了植入物类型与全因死亡率、新发心力衰竭、癌症和神经退行性疾病风险之间的关联。
有158677名个体（42.4%）植入了含钴铬合金的植入物。共有47963例死亡、27332例心脏疾病、35720例癌症和22025例神经退行性疾病。没有证据表明植入钴铬合金的患者在任何一种结局方面的发生率更高。
含钴铬合金全髋关节置换术在植入后第二个十年内，全因死亡率、具有临床意义的心脏疾病、癌症或神经退行性疾病风险并未增加。我们的研究结果将有助于让临床医生以及全球越来越多接受初次全髋关节置换术的患者放心，即使用含钴铬合金的植入物不会产生显著的不良全身影响。
