Busigó Torres Rodnell, Hong James, Kodali Hanish, Poeran Jashvant, Stern Brocha Z, Hayden Brett L, Chen Darwin D, Moucha Calin S
Leni and Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York.
Leni and Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York; Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.
J Arthroplasty. 2025 Mar;40(3):700-704.e1. doi: 10.1016/j.arth.2024.08.043. Epub 2024 Sep 2.
Bisphosphonate (BP) use is not uncommon among total hip arthroplasty (THA) candidates. While the impact of BP therapy post-THA has been investigated, there is a paucity of literature discussing the impact of BP therapy pre-THA. Using a national dataset, we aimed to study the association between preoperative BP use and surgical outcomes in primary THA recipients.
This retrospective cohort study used a commercial claims and Medicare Supplemental database to identify adults aged ≥ 18 years who had an index nonfracture-related primary THA from 2016 to 2020. The use of BP was defined as ≥ 6 months of BP therapy in the year prior to THA. Outcomes were 90-day all-cause readmission, 90-day readmission related to periprosthetic fracture (PPF), 90-day and 1-year all-cause revision, 1-year PPF-related revision, and 1-year diagnosis of PPF. In a 1:5 propensity score-matched analysis, each THA patient who had preoperative BP use was matched to five THA patients who did not have preoperative BP use. Logistic regression models were fitted; we report odds ratios (ORs) and 95% confidence intervals (CIs).
Of 91,907 THA patients, 1,018 (1.1%) used BP preoperatively. In the propensity score-matched cohort (1,018 preoperative BP users and 5,090 controls), preoperative BP use was significantly associated with increased odds of 90-day all-cause revision surgery (OR 1.67; 95% CI 1.10 to 2.53; P = 0.02), 1-year PPF-related revision (OR 2.23; 95% CI 1.21 to 4.10; P = 0.01), and 1-year PPF diagnosis (OR 1.88; 95% CI 1.10 to 3.20; P = 0.02). There were no statistically significant associations between preoperative BP use and the other outcomes in the matched cohort.
These findings suggest that preoperative BP use is associated with an increased risk of revision surgery and PPF in both the short and long term. This information can help in preoperative planning and patient counseling, potentially leading to improved surgical outcomes and reduced complication rates.
双膦酸盐（BP）在全髋关节置换术（THA）候选患者中使用并不罕见。虽然已对THA术后BP治疗的影响进行了研究，但讨论THA术前BP治疗影响的文献却很少。我们使用全国性数据集，旨在研究初次THA接受者术前BP使用与手术结果之间的关联。
这项回顾性队列研究使用商业索赔和医疗保险补充数据库，以识别2016年至2020年期间接受首次非骨折相关初次THA的18岁及以上成年人。BP的使用定义为THA术前一年接受BP治疗≥6个月。观察指标包括90天全因再入院、90天与假体周围骨折（PPF）相关的再入院、90天和1年全因翻修、1年与PPF相关的翻修以及1年PPF诊断。在1:5倾向评分匹配分析中，将每位术前使用BP的THA患者与五位未术前使用BP的THA患者进行匹配。拟合逻辑回归模型；我们报告比值比（OR）和95%置信区间（CI）。
在91,907例THA患者中，1,018例（1.1%）术前使用BP。在倾向评分匹配队列（1,018例术前BP使用者和5,090例对照）中，术前使用BP与90天全因翻修手术几率增加显著相关（OR 1.67；95%CI 1.10至2.53；P = 0.02）、1年与PPF相关的翻修（OR 2.23；95%CI 1.21至4.10；P = 0.01）以及1年PPF诊断（OR 1.88；95%CI 1.10至3.20；P = 0.02）。在匹配队列中，术前使用BP与其他观察指标之间无统计学显著关联。
这些发现表明，术前使用BP在短期和长期内均与翻修手术风险增加和PPF相关。这些信息有助于术前规划和患者咨询，可能改善手术结果并降低并发症发生率。
