Warren Alpert Medical School of Brown University, Providence, Rhode Island.
Department of Orthopaedics, Brown University Warren Alpert Medical School, Providence, Rhode Island.
J Arthroplasty. 2024 Apr;39(4):954-959.e1. doi: 10.1016/j.arth.2023.10.015. Epub 2023 Oct 17.
The cellular mechanisms underlying excess scar tissue formation in arthrofibrosis following total knee arthroplasty (TKA) are well-described. Angiotensin receptor blockers (ARB), particularly losartan, is a commonly prescribed antihypertensive with demonstrated antifibrotic properties. This retrospective study aimed to assess the rates of 1- and 2-year postoperative complications in patients who filled prescriptions for ARBs during the 90 days after TKA.
Patients undergoing primary TKA were selected from a large national insurance database, and the impact of ARB use after TKA on complications was assessed. Of the 1,299,106 patients who underwent TKA, 82,065 had filled at least a 90-day prescription of losartan, valsartan, or olmesartan immediately following their TKA. The rates of manipulation under anesthesia (MUA), arthroscopic lysis of adhesions (LOA), aseptic loosening, periprosthetic fracture, and revision at 1 and 2 years following TKA were analyzed using multivariable logistic regressions to control for various comorbidities.
ARB use was associated with decreased rates of MUA (odds ratio [OR] = 0.94, 95% confidence interval (CI), 0.90 to 0.99), arthroscopy/LOA (OR = 0.86, 95% CI, 0.77 to 0.95), aseptic loosening (OR = 0.71, 95% CI, 0.61 to 0.83), periprosthetic fracture (OR = 0.58, 95% CI, 0.46 to 0.71), and revision (OR = 0.79, 95% CI, 0.74 to 0.85) 2 years after TKA.
ARB use throughout the 90 days after TKA is associated with a decreased risk of MUA, arthroscopy/LOA, aseptic loosening, periprosthetic fracture, and revision, demonstrating the potential protective abilities of ARBs. Prospective studies evaluating the use of ARBs in patients at risk for postoperative stiffness would be beneficial to further elucidate this association.
全膝关节置换术后关节纤维化中过度瘢痕组织形成的细胞机制已得到充分描述。血管紧张素受体阻滞剂（ARB），特别是氯沙坦，是一种常用的降压药，具有抗纤维化特性。这项回顾性研究旨在评估在膝关节置换术后 90 天内服用 ARB 处方的患者在 1 年和 2 年时术后并发症的发生率。
从一个大型国家保险数据库中选择接受初次膝关节置换术的患者，并评估膝关节置换术后 ARB 应用对并发症的影响。在 1299106 例接受膝关节置换术的患者中，有 82065 例患者在膝关节置换术后立即至少服用了 90 天的氯沙坦、缬沙坦或奥美沙坦处方。使用多变量逻辑回归分析来控制各种合并症，分析膝关节置换术后 1 年和 2 年时接受麻醉下手法松解术（MUA）、关节镜下粘连松解术（LOA）、无菌性松动、假体周围骨折和翻修的比率。
ARB 的使用与 MUA（比值比[OR] 0.94，95%置信区间[CI] 0.90 至 0.99）、关节镜/LOA（OR 0.86，95%CI 0.77 至 0.95）、无菌性松动（OR 0.71，95%CI 0.61 至 0.83）、假体周围骨折（OR 0.58，95%CI 0.46 至 0.71）和翻修（OR 0.79，95%CI 0.74 至 0.85）的风险降低相关。
膝关节置换术后 90 天内使用 ARB 与 MUA、关节镜/LOA、无菌性松动、假体周围骨折和翻修的风险降低相关，这表明 ARB 具有潜在的保护作用。评估 ARB 在术后僵硬风险患者中的应用的前瞻性研究将有助于进一步阐明这种关联。
