Use of diuretics and risk of implant failure after primary total hip arthroplasty: a nationwide population-based study

Thiazid and loop diuretics have been associated with changes in bone mineral density and fracture risk. However, data on survival of prosthesis implants are lacking. We evaluated the association between diuretic use and the risk of revision after primary total hip arthroplasty (THA).

We conducted a nationwide population-based case-control study using medical databases in Denmark. In the Danish Hip Arthroplasty Registry, we identified 2491 cases that were revised after primary THA in the period 1995-2005 and who could be matched on age, gender and year of primary operation with 4943 non-revised THA controls. By means of conditional logistic regression, we estimated the relative risk (RR) of revision due to all causes and due to specific causes according to postoperative use of thiazid and loop diuretic, respectively.

The 10-year cumulated implant revision rate in the underlying cohort of 57,575 THA procedures from the Danish Hip Arthroplasty Registry was 8.9% (95% CI: 8.4-9.4). Postoperative thiazid diuretic use was not associated with neither the overall risk of revision nor revision due to specific causes compared to non-use. Postoperative loop diuretic use was associated with an adjusted RR of revision of 1.14 (95% CI; 0.98-1.32) compared with non-use. The adjusted RR of revision due to deep infection and periprosthetic fracture in loop diuretic users was 1.71 (1.15-2.55) and 6.39 (1.84-22.21), respectively. Loop diuretic use was not associated with risk of revision due to aseptic loosening, dislocation or miscellaneous causes.

Loop diuretics but not thiazides may be associated with an increased risk of revision following primary THA. Further studies are warranted in order to confirm this finding and clarify the nature of the association.