Harris Andrew B, Agarwal Amil R, Hegde Vishal, Oni Julius K, Khanuja Harpal S
Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Orthopaedic Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia.
J Arthroplasty. 2025 Mar;40(3):597-601.e1. doi: 10.1016/j.arth.2024.08.042. Epub 2024 Sep 2.
Proton pump inhibitors (PPIs) are often prescribed in conjunction with nonsteroidal anti-inflammatory drugs after total hip arthroplasty (THA) and total knee arthroplasty (TKA) due to their gastroprotective effects. In animal studies, it has been suggested that PPIs have immunosuppressive effects and impair fracture healing; however, the association between PPI use and adverse events following THA and TKA has not been well-studied.
An administrative claims database was queried for patients who underwent elective THA from 2010 to 2019. The experimental group consisted of patients who did not have a prior history of gastrointestinal bleeding or gastroesophageal reflux disease and who received a PPI prescription in the perioperative period. A 1:1 propensity score matching was used to create control cohorts of patients who did not have any PPI prescription filled, also matching for age, sex, and the Charlson Comorbidity Index. This same cohort selection and matching procedure was then repeated for patients undergoing elective TKA. In total, 11,450 patients were studied (3,103 TKA + PPI, 2,622 THA + PPI, 3,103 TKA controls, and 2,622 THA controls). The mean age was 64 years (range, 38 to 94), and 57% were women. Significance was considered at P < 0.05.
Perioperative PPI prescription in TKA patients was associated with significantly lower rates of all-cause revision (3.0 versus 4.1%, P < 0.01) and periprosthetic joint infection (1.0 versus 1.8%, P < 0.01). In THA patients, PPI prescription was associated with a lower all-cause revision rate (2.8 versus 4.0%, P = 0.02). No significant differences were found between PPI and non-PPI groups for aseptic loosening, periprosthetic fracture, gastrointestinal bleeding, or surgical site infection in either cohort.
Patients receiving routine PPI prescriptions in the perioperative period surrounding TKA and THA have a lower risk of all-cause revision surgery, and perioperative PPI use is associated with a decreased risk of PJI in patients undergoing TKA. As these results conflict with the few previous studies performed on this topic, additional controlled studies are warranted to fully elucidate the relationship between PPI use and adverse events after THA and TKA.
由于质子泵抑制剂（PPIs）具有胃保护作用，全髋关节置换术（THA）和全膝关节置换术（TKA）后常与非甾体抗炎药联合使用。在动物研究中，有人提出PPIs具有免疫抑制作用并会损害骨折愈合；然而，THA和TKA后使用PPI与不良事件之间的关联尚未得到充分研究。
查询2010年至2019年接受择期THA患者的行政索赔数据库。实验组由既往无胃肠道出血或胃食管反流病病史且在围手术期接受PPI处方的患者组成。采用1:1倾向评分匹配法创建未开具任何PPI处方的患者对照队列，并匹配年龄、性别和Charlson合并症指数。然后对接受择期TKA的患者重复相同的队列选择和匹配程序。总共研究了11450名患者（3103例TKA + PPI，2622例THA + PPI，3103例TKA对照，2622例THA对照）。平均年龄为64岁（范围38至94岁），57%为女性。P < 0.05被认为具有统计学意义。
TKA患者围手术期使用PPI与全因翻修率（3.0%对4.1%，P < 0.01）和假体周围感染率（1.0%对1.8%，P < 0.01）显著降低相关。在THA患者中，PPI处方与较低的全因翻修率相关（2.8%对4.0%，P = 0.02）。在任一队列中，PPI组和非PPI组在无菌性松动、假体周围骨折、胃肠道出血或手术部位感染方面均未发现显著差异。
在TKA和THA围手术期接受常规PPI处方的患者全因翻修手术风险较低，TKA患者围手术期使用PPI与PJI风险降低相关。由于这些结果与之前关于该主题的少数研究结果相矛盾，因此有必要进行更多对照研究以充分阐明THA和TKA后PPI使用与不良事件之间的关系。
