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Increased Long-Term Cardiovascular Risk After Total Hip Arthroplasty: A Nationwide Cohort Study
Max Gordon1, Agata Rysinska, Anne Garland
1From the Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden (MG, AR, SA, TE, AS, OS); Department of Orthopedics, Institute of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden (AG, NH); Swedish Hip Arthroplasty Register, Registercentrum VGR, Gothenburg, Sweden (OR, GG); Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (OR, GG); and Harris Orthopedic Laboratory, Massachusetts General Hospital and Harvard Medical School (OR), Boston, MA.
Insights
Total hip arthroplasty (THA) patients face increased cardiovascular mortality and morbidity risks years after surgery. This study found that while initial risks are lower, THA patients experience a higher risk of heart issues after 8.8 years compared to controls.
Area of Science:
- Orthopedics
- Cardiology
- Epidemiology
Background:
- Osteoarthritis (OA) is a prevalent condition managed with total hip arthroplasty (THA).
- Long-term cardiovascular (CV) effects of OA or THA implants are not well understood.
- Investigating late-onset CV risks post-THA is crucial for patient management.
Purpose of the Study:
- To assess the risk of late cardiovascular mortality and morbidity following THA.
- To determine if THA surgery increases the likelihood of CV events in OA patients.
Main Methods:
- Nationwide matched cohort study using Swedish Hip Arthroplasty Register data.
- 91,527 OA patients undergoing THA were matched 1:3 with 270,688 controls from the general population.
- Mean follow-up of 10 years, analyzing CV mortality, total mortality, and CV re-admissions after 5 years.
Main Results:
- Initially, THA patients showed lower CV mortality risk (0-9 years).
- After 8.8 years, CV mortality risk increased significantly in the THA cohort (HR 1.11, 95% CI 1.05-1.17, 9-13 years).
- THA patients had higher rates of hospital admissions for CV events (RR 1.08, 95% CI 1.06-1.11).
Conclusions:
- Surgically treated OA patients have an elevated risk of CV morbidity and mortality many years post-THA.
- Late cardiovascular complications should be considered in long-term OA patient follow-up.
- Further research into the mechanisms behind late CV risks post-THA is warranted.
Abstract:
Total hip arthroplasty is a common and important treatment for osteoarthritis patients. Long-term cardiovascular effects elicited by osteoarthritis or the implant itself remain unknown. The purpose of the present study was to determine if there is an increased risk of late cardiovascular mortality and morbidity after total hip arthroplasty surgery.A nationwide matched cohort study with data on 91,527 osteoarthritis patients operated on, obtained from the Swedish Hip Arthroplasty Register. A control cohort (n = 270,688) from the general Swedish population was matched 1:3 to each case by sex, age, and residence. Mean follow-up time was 10 years (range, 7-21).The exposure was presence of a hip replacement for more than 5 years. The primary outcome was cardiovascular mortality after 5 years. Secondary outcomes were total mortality and re-admissions due to cardiovascular events.During the first 5 to 9 years, the arthroplasty cohort had a lower cardiovascular mortality risk compared with the control cohort. However, the risk in the arthroplasty cohort increased over time and was higher than in controls after 8.8 years (95% confidence interval [CI] 7.0-10.5). Between 9 and 13 years postoperatively, the hazard ratio was 1.11 (95% CI 1.05-1.17). Arthroplasty patients were also more frequently admitted to hospital for cardiovascular reasons compared with controls, with a rate ratio of 1.08 (95% CI 1.06-1.11).Patients with surgically treated osteoarthritis of the hip have an increased risk of cardiovascular morbidity and mortality many years after the operation when compared with controls.
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