术前使用双膦酸盐对全髋关节置换术结果的影响。
The Effect of Preoperative Bisphosphonate Use on Total Hip Arthroplasty Outcomes.
机构信息
Department of Medicine, Medstar Georgetown University, Washington, District of Columbia.
Department of Orthopaedics, MedStar Union Memorial Hospital, Baltimore, Maryland.
出版信息
J Arthroplasty. 2023 Nov;38(11):2393-2397.e2. doi: 10.1016/j.arth.2023.05.027. Epub 2023 May 24.
BACKGROUND
Patients undergoing total hip arthroplasty (THA) commonly have osteoporosis for which bisphosphonates (BPs) are Food and Drug Administration (FDA)-approved for treatment. Bisphosphonate use post-THA is associated with decreased periprosthetic bone loss or revisions, and increased longevity of implants. However, evidence is lacking for preoperative bisphosphonate use in THA recipients. This study investigated the association between bisphosphonate use pre-THA and outcomes.
METHODS
A retrospective review of a national administrative claims database was conducted. Among THA recipients who had a prior diagnosis of hip osteoarthritis and osteoporosis/osteopenia, the treatment group (BP-exposed) consisted of patients who had a history of bisphosphonate use at least 1 year before THA; controls (BP-naive) comprised patients who did not have preoperative bisphosphonate use. The BP-exposed were matched to BP-naive in a 1:4 ratio by age, sex, and comorbidities. Logistic regressions were used to calculate the odds ratio for intraoperative and 1-year postoperative complications.
RESULTS
The BP-exposed group had significantly higher rates of intraoperative and 1-year postoperative periprosthetic fractures (odds ratio (OR): 1.39, 95% confidence interval (CI): 1.23, 1.57) and revisions (OR: 1.14, 95% CI: 1.04, 1.25) compared with the BP-naive controls. BP-exposed also experienced higher rates of aseptic loosening, dislocation, periprosthetic osteolysis, and stress fracture of the femur or hip/pelvis compared to the BP-naive controls, but these values were not statistically significant.
CONCLUSION
The use of bisphosphonates in THA patients preoperatively is associated with higher rates of intraoperative and 1-year postoperative complications. These findings may impact the management of patients undergoing THA who have a prior diagnosis of osteoporosis/osteopenia and use of bisphosphonates.
LEVEL OF EVIDENCE
Retrospective Cohort Study (Level 3).
背景
接受全髋关节置换术（THA）的患者通常患有骨质疏松症，双膦酸盐（BPs）已获得美国食品和药物管理局（FDA）批准用于治疗。THA 后使用双膦酸盐与减少假体周围骨丢失或翻修以及增加植入物的使用寿命有关。然而，THA 受者术前使用双膦酸盐的证据不足。本研究调查了 THA 前使用双膦酸盐与结果之间的关系。
方法
对国家行政索赔数据库进行了回顾性分析。在患有髋关节骨关节炎和骨质疏松症/骨量减少先前诊断的 THA 受者中，治疗组（BP 暴露组）由至少在 THA 前 1 年有双膦酸盐使用史的患者组成；对照组（BP 未使用组）由术前未使用双膦酸盐的患者组成。BP 暴露组与 BP 未使用组按年龄、性别和合并症进行 1:4 匹配。使用逻辑回归计算术中及术后 1 年并发症的优势比。
结果
BP 暴露组术中及术后 1 年发生假体周围骨折的发生率明显高于 BP 未使用组（优势比（OR）：1.39，95%置信区间（CI）：1.23，1.57）和翻修率（OR：1.14，95%CI：1.04，1.25）。与 BP 未使用对照组相比，BP 暴露组还经历了更高的无菌性松动、脱位、假体周围骨溶解以及股骨或髋部/骨盆的应力性骨折发生率，但这些值没有统计学意义。
结论
THA 患者术前使用双膦酸盐与更高的术中及术后 1 年并发症发生率相关。这些发现可能会影响患有骨质疏松症/骨量减少且使用双膦酸盐的 THA 患者的管理。
证据水平
回顾性队列研究（第 3 级）。
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