Luminis Health Orthopedics, Anne Arundel Medical Center, 2000 Medical Parkway, Suite 503, Annapolis, MD 21401, United States.
Luminis Health Orthopedics, Anne Arundel Medical Center, 2000 Medical Parkway, Suite 503, Annapolis, MD 21401, United States.
Orthop Traumatol Surg Res. 2024 Nov;110(7):103851. doi: 10.1016/j.otsr.2024.103851. Epub 2024 Feb 28.
Total knee arthroplasty (TKA) is a common surgical procedure performed to alleviate pain and improve functional outcomes in patients with knee osteoarthritis and rheumatoid arthritis who have failed conservative treatments. Arthrofibrosis has been extensively studied due to its negative impact on TKA outcomes. Losartan, an angiotensin receptor blocker (ARB), has the potential to improve TKA outcomes by inhibiting TGF-β and decreasing fibrosis. This study aims to analyze a large-scale, real-world healthcare database to investigate the association between losartan potassium prescription and postoperative outcomes such as readmissions, ED visits, and the need for MUA or revision TKA.
Based on previous literature and the nature of ARBs, it is expected that the addition of losartan will aid in better outcomes for patients following a primary TKA.
In this retrospective observational study, the TriNetX Research Network (TriNetX) database was queried as of June 21, 2023. All patients who underwent a primary total knee arthroplasty (TKA) prior to June 21, 2022 were included. Patients were then divided into two cohorts by whether they had an active losartan potassium prescription within the year prior to their surgery to within 90days postoperatively. Patients were then propensity-matched to eliminate differences in demographics and comorbidities.
Losartan TKA patients were 1.18 [OR: 0.85 (95% CI: 0.79-0.90), p<0.001] times less likely to be readmitted within 90days and were 1.15 (OR: 0.87 (95% CI: 0.79-0.96); p=0.009) times less likely to undergo a manipulation under anesthesia (MUA) within the 1-year postoperative period. There were no statistically significant differences in rates of emergency department (ED) visits at 90days postoperatively or revision TKAs at 1year postoperatively.
In conclusion, patients with an active losartan prescription prior to TKA had a significantly lower likelihood of readmission within 90days and a lower likelihood of undergoing MUA within the 1-year postoperative period compared to patients not taking losartan. This presents an opportunity for further clinical investigation to explore the value of losartan in TKA.
III; an observational cohort study.
全膝关节置换术（TKA）是一种常见的手术，用于缓解膝关节骨关节炎和类风湿关节炎患者的疼痛并改善其功能，这些患者经保守治疗后无效。由于其对 TKA 结果的负面影响，关节纤维化已得到广泛研究。氯沙坦钾是一种血管紧张素受体阻滞剂（ARB），具有通过抑制 TGF-β和减少纤维化来改善 TKA 结果的潜力。本研究旨在分析一个大规模的真实世界医疗保健数据库，以调查氯沙坦钾处方与术后结果（如再入院、急诊就诊和需要手法复位或翻修 TKA）之间的关联。
基于先前的文献和 ARB 的性质，预计在初次 TKA 后，添加氯沙坦将有助于患者获得更好的结果。
在这项回顾性观察性研究中，截至 2023 年 6 月 21 日，检索了 TriNetX 研究网络（TriNetX）数据库。所有在 2022 年 6 月 21 日之前接受初次全膝关节置换术（TKA）的患者均被纳入研究。然后，根据患者在手术前一年至术后 90 天内是否有氯沙坦钾的有效处方，将患者分为两组。然后通过倾向评分匹配消除人口统计学和合并症的差异。
氯沙坦 TKA 患者在 90 天内再入院的可能性低 1.18 倍[比值比（OR）：0.85（95%置信区间：0.79-0.90），p<0.001]，并且在术后 1 年内接受麻醉下手法复位（MUA）的可能性低 1.15 倍[比值比（OR）：0.87（95%置信区间：0.79-0.96）；p=0.009]。术后 90 天内急诊就诊或术后 1 年内翻修 TKA 的发生率无统计学差异。
总之，与未服用氯沙坦的患者相比，术前服用氯沙坦的患者在 90 天内再入院的可能性显著降低，在术后 1 年内接受 MUA 的可能性也降低。这为进一步的临床研究提供了机会，以探索氯沙坦在 TKA 中的价值。
III；观察性队列研究。
