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Increased risk of chronic osteomyelitis after hip replacement: a retrospective population-based cohort study in an
Insights
Hip replacement surgery significantly increases the risk of developing chronic osteomyelitis (COM) in Asian populations. This risk is notably higher in younger males and within the first year post-surgery.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Epidemiology
Background:
- Chronic osteomyelitis (COM) is a serious bone infection.
- The association between hip replacement (Hip-Repl) and COM risk is not well-established in Asian populations.
Purpose of the Study:
- To investigate the risk of developing COM following hip replacement surgery in an Asian population.
- To identify patient subgroups with elevated COM risk after Hip-Repl.
Main Methods:
- Population-based, nationwide, retrospective cohort study using Taiwan's Longitudinal Health Insurance Database 2000.
- Included 5349 Hip-Repl patients and 10,372 matched controls, excluding those with prior COM.
- Utilized Cox proportional hazards regression to calculate adjusted hazard ratios (aHRs) for COM development.
Main Results:
- Hip-Repl patients had a 4.18-fold higher risk of developing COM compared to controls.
- The risk was substantially higher in patients aged ≤65 years (10.0-fold) and males.
- Increased COM risk was observed in both patients with and without comorbidities, with a higher impact in those without.
Conclusions:
- Hip replacement surgery is associated with a significantly increased risk of developing chronic osteomyelitis.
- Younger patients (≤65 years), males, and those within the first postoperative year face a higher risk.
- Further research and preventative strategies are warranted for this patient population.
Abstract:
The correlation between hip replacement (Hip-Repl) and chronic osteomyelitis (COM) has not been studied in Asian populations. Thus, we assessed Hip-Repl-related risk of developing COM via a population-based, nationwide, retrospective cohort study. The Hip-Repl cohort was obtained from Taiwan's Longitudinal Health Insurance Database 2000, and included patients who underwent Hip-Repl between 2000 and 2010; the control cohort was also selected from this database. Patients with a history of COM were excluded in both cohorts. We used univariate and multivariate Cox proportional hazards regression models to calculate the adjusted hazard ratios (aHRs) by age, sex, and comorbidities for developing COM. A total of 5349 patients who received a Hip-Repl and 10,372 matched controls were enrolled. In the Hip-Repl group, the risk for COM was 4.18-fold [95 % confidence interval (CI) = 2.24-7.80] higher than that in the control group after adjustment. For patients aged ≤65 years, the risk was 10.0-fold higher (95 % CI = 2.89-34.6). Furthermore, the risk was higher in the Hip-Repl cohort than in the non-Hip-Repl cohort, for both patients without comorbidity (aHR = 16.5, 95 % CI = 2.07-132.3) and those with comorbidity (aHR = 3.49, 95 % CI = 1.78-6.83). The impact of Hip-Repl on the risk for COM was greater among patients not using immunosuppressive drugs, and occurred during the first postoperative year. Patients who received Hip-Repl have an increased risk of developing COM. This risk was higher among males and patients aged 65 years or younger, and during the first postoperative year.
