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Published on: February 27, 2018
Aseptic loosening after total hip arthroplasty and the risk of cardiovascular disease: A nested case-control study
Agata Rysinska1, Olof Sköldenberg1, Anne Garland2
1Karolinska Institutet, Department of Clinical Sciences at Danderyd Hospital, Stockholm, Stockholm, Sweden.
Insights
Patients undergoing total hip arthroplasty (THA) for osteoarthritis with implant loosening face a higher risk of cardiovascular events. This suggests a potential link between inflammatory pathways and post-operative complications.
Area of Science:
- Orthopedic Surgery
- Cardiovascular Medicine
- Inflammatory Diseases
Background:
- Patients with surgically treated hip osteoarthritis have increased cardiovascular risks post-operation.
- Total hip arthroplasty (THA) may be linked to periprosthetic osteolysis and aseptic loosening.
- The study investigates the association between THA complications and cardiovascular events.
Purpose of the Study:
- To determine if periprosthetic osteolysis and aseptic loosening after THA increase cardiovascular morbidity and mortality.
- To explore the potential mediating role of implant complications in the cardiovascular risk observed in osteoarthritis patients.
Main Methods:
- A nationwide nested case-control study using Swedish registers (1992-2005).
- Included 14,430 patients receiving cemented THA for osteoarthritis.
- Cases (n=2,886) had reoperation for osteolysis/loosening within five years; controls (n=11,544) did not.
Main Results:
- The case group (reoperation for loosening) showed an adjusted increased relative risk of 1.3 for cardiovascular events.
- Similar increased risks were observed for the time to the first cardiovascular event.
- While controls had slightly more overall events initially, adjusted analysis revealed higher risk in the case group.
Conclusions:
- Patients with osteoarthritis undergoing THA revision due to loosening have a higher relative risk of cardiovascular events.
- An association exists, potentially explained by a common inflammatory disease pathway.
- Further experimental research is warranted to elucidate the underlying mechanisms.
Background:
Patients with surgically treated osteoarthritis of the hip have an increased risk of cardiovascular morbidity and mortality many years after the operation compared with controls. Our hypothesis is that this increased risk after total hip arthroplasty (THA) is mediated by development of periprosthetic osteolysis leading to aseptic loosening of the implant.
Methods:
We conducted a nation-wide, nested, case-control study consisting of patients receiving a cemented THA due to osteoarthritis between the years 1992 and 2005. Our study population included a total of 14,430 subjects identified in the Swedish hip arthroplasty register and linked to the Swedish National Patient Register. The case group consisted of patients (n = 2,886) who underwent reoperation of the treated hip due to osteolysis or aseptic loosening at any time within five years after the index surgery. Each case was matched with four controls (n = 11,544) who had not undergone reoperation. The main outcomes were cardiovascular events i.e. myocardial infarction, heart failure and cerebral infarction according to ICD-codes and time to the first cardiovascular event during the exposure period. Outcomes were subgrouped into cardiac and cerebral events. We used regression models to calculate the incidence rates and adjusted our results for confounders.
Findings:
Overall, 5.1% of patients had cardiac events, with slightly more overall cardiovascular events occurring in the control group (8.1% vs. 6.7%, odds ratio 0.8, 95% confidence interval (CI) 0.7 to 1.0). After adjusting for confounders, the case group had an increased relative risk of 1.3 (95% confidence interval (CI) 1.1 to 1.3) for total number of cardiovascular events. Similar effect sizes were observed for time to first event.
Interpretation:
Patients with osteoarthritis who received THA and subsequently underwent a revision operation due to loosening had a higher relative risk of developing cardiovascular events than controls. Thus there is an association which could be explained by a common inflammatory disease pathway that requires further experimental research.
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