Department of Orthopaedic Surgery, The First Affiliated Hospital of Xinxiang Medical University, Weihui, China.
Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA.
Clin Orthop Surg. 2024 Aug;16(4):542-549. doi: 10.4055/cios24039. Epub 2024 Jul 12.
Gout is the most prevalent form of inflammatory arthritis in the world. Total hip arthroplasty (THA) has emerged as a widely sought-after and highly effective surgical procedure for advanced hip diseases. However, there is a lack of research on the impact of gout on primary THA outcomes in large cohorts. This study aimed to address this gap by primarily investigating complications following THA in patients with or without gout.
Patients with records of gout in the 2 years leading up to their primary THA and who also have at least 2 years of follow-up were identified using a national insurance database and compared to a 5:1 matched control. A total of 32,466 patients with gout and 161,514 patients without gout undergoing THA were identified. Multivariable logistic regression analyses were done for medical complications up to 90 days and surgical complications up to 2 years. In addition, 90-day emergency department (ED) visits and inpatient readmission were also documented.
Patients with gout demonstrated higher rates of medical complications including deep vein thrombosis, transfusion, acute kidney injury, and urinary tract infection than non-gout patients ( < 0.001). Gout patients also showed higher rates of pulmonary embolism ( = 0.017). Increased incidences of surgical complications were identified in gout patients, specifically wound complications and periprosthetic joint infection ( < 0.001). There was an increased risk of revision for gout patients up to 90 days ( = 0.003), 1 year ( = 0.027), and 2 years ( = 0.039). There was also an increased risk of dislocation for gout patients up to 90 days ( = 0.022) and 1 year ( = 0.047), but not at 2 years. No significant difference was observed in aseptic loosening or periprosthetic fracture. Additionally, gout patients also demonstrated a higher likelihood of 90-day ED visits and readmission ( < 0.001).
Primary THA in gout patients is associated with increased risks of multiple medical and surgical complications. Our findings provide insights into the planning and expectation of THA for patients with gout. These insights have the potential to benefit the decision-making process for gout patients considering THA.
痛风是世界上最常见的炎症性关节炎形式。全髋关节置换术（THA）已成为治疗晚期髋关节疾病的广泛应用且非常有效的手术方法。然而，在大型队列中，关于痛风对初次 THA 结果的影响的研究还很少。本研究旨在通过主要研究痛风患者和无痛风患者在初次 THA 后的并发症来填补这一空白。
使用国家保险数据库确定在初次 THA 前 2 年内有痛风记录且至少有 2 年随访记录的患者，并与 5:1 匹配对照进行比较。共确定了 32466 例痛风患者和 161514 例无痛风患者接受 THA。对 90 天内的医疗并发症和 2 年内的手术并发症进行多变量逻辑回归分析。此外，还记录了 90 天急诊（ED）就诊和住院再入院情况。
与无痛风患者相比，痛风患者的医疗并发症发生率更高，包括深静脉血栓形成、输血、急性肾损伤和尿路感染（<0.001）。痛风患者还显示出更高的肺栓塞发生率（=0.017）。痛风患者的手术并发症发生率也有所增加，特别是伤口并发症和假体周围关节感染（<0.001）。痛风患者在 90 天（=0.003）、1 年（=0.027）和 2 年（=0.039）时需要翻修的风险增加。痛风患者在 90 天（=0.022）和 1 年（=0.047）时脱位的风险增加，但在 2 年时没有增加。在无菌性松动或假体周围骨折方面没有发现显著差异。此外，痛风患者在 90 天内就诊和再入院的可能性也更高（<0.001）。
痛风患者初次 THA 与多种医疗和手术并发症的风险增加有关。我们的研究结果为痛风患者的 THA 规划和预期提供了新的认识。这些见解有可能有益于考虑 THA 的痛风患者的决策过程。
