全关节置换术后心力衰竭的长期风险：一项基于人群的队列研究。
Long-Term Risk of Heart Failure in Total Joint Arthroplasty: A Population-Based Cohort Study.
作者信息
Hu Mingzhao, Turner Lindsey E, Slusser Joshua P, Vassilaki Maria, Berry Daniel J, Lewallen David G, Kremers Walter K, Maradit Kremers Hilal
机构信息
Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota.
Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota; School of Public Health, University of Minnesota, Minneapolis, Minnesota.
出版信息
J Arthroplasty. 2025 May 19. doi: 10.1016/j.arth.2025.05.042.
BACKGROUND
Previous case reports raised concerns about the cardiovascular effects of metal particles and ions produced by mechanical wear and corrosion of total joint arthroplasty (TJA) implants. We compared the long-term risk of heart failure in a cohort of individuals who had TJA and in a general population comparison cohort.
METHODS
This was a population-based, retrospective cohort study of 7,182 TJA subjects who first had total hip arthroplasty (THA) or total knee arthroplasty surgeries between 1990 and 2020 and 7,407 age-, sex-, and calendar year-matched non-TJA subjects. All subjects were followed up until death, incident heart failure, migration, or 2020. The medical records were reviewed to collect data on surgical history, cardiovascular risk factors, and heart failure outcomes. Poisson regression models were used to estimate the risk of heart failure in TJA subjects, accounting for the competing risk of death and adjusting for cardiovascular risk factors.
RESULTS
At baseline, TJA subjects had a higher prevalence of several cardiovascular risk factors than the non-TJA subjects. The risk of heart failure in TJA subjects was similar to the general population during the first decade after surgery. However, the risk increased over time, and by the second decade after surgery, the risk of heart failure in both the THA (hazard ratio 1.34, 95% confidence interval [CI]: 1.13 to 1.58) and total knee arthroplasty (hazard ratio 1.33, 95% confidence interval: 1.16 to 1.53) subjects was higher than the non-TJA subjects. The long-term risk of heart failure was higher among THA subjects with cobalt-chromium-containing implants and those who underwent surgery for fractures and inflammatory arthritis.
CONCLUSIONS
We observed a higher risk of heart failure beyond the first decade after TJA surgery. However, the magnitude of the risk is small and should be interpreted with caution due to the possibility of informative presence and confounding bias.
背景
先前的病例报告引发了人们对全关节置换术（TJA）植入物机械磨损和腐蚀产生的金属颗粒及离子对心血管影响的担忧。我们比较了接受TJA的人群队列和一般人群对照队列中发生心力衰竭的长期风险。
方法
这是一项基于人群的回顾性队列研究，纳入了7182例于1990年至2020年间首次接受全髋关节置换术（THA）或全膝关节置换术的TJA受试者，以及7407例年龄、性别和历年匹配的非TJA受试者。所有受试者均随访至死亡、发生心力衰竭、迁移或2020年。查阅病历以收集手术史、心血管危险因素和心力衰竭结局的数据。采用泊松回归模型估计TJA受试者发生心力衰竭的风险，同时考虑死亡的竞争风险并对心血管危险因素进行校正。
结果
在基线时，TJA受试者中几种心血管危险因素的患病率高于非TJA受试者。TJA受试者在术后第一个十年中心力衰竭风险与一般人群相似。然而，风险随时间增加，到术后第二个十年，THA（风险比1.34，95%置信区间[CI]：1.13至1.58）和全膝关节置换术（风险比1.33，95%置信区间：1.16至1.53）受试者的心力衰竭风险均高于非TJA受试者。含钴铬植入物的THA受试者以及接受骨折和炎性关节炎手术的受试者发生心力衰竭的长期风险更高。
结论
我们观察到TJA手术后十年以上心力衰竭风险更高。然而，由于可能存在信息偏倚和混杂偏倚，该风险程度较小，应谨慎解读。
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