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Asymptomatic osteolysis as a risk factor for cardiovascular disease after total hip arthroplasty: A retrospective
Agata Rysinska1,2, Sara Aspberg1,3,4, Thomas Eisler1,2
1Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Orthopaedics, Stockholm, Sweden.
Insights
Total hip arthroplasty patients with periacetabular osteolysis showed a trend towards higher cardiovascular disease incidence. Further research is needed to confirm if peri-implant inflammation increases long-term cardiovascular disease risk after total hip arthroplasty.
Area of Science:
- Orthopedic Surgery
- Cardiovascular Disease Epidemiology
- Biomaterials Science
Background:
- Periprosthetic osteolysis, a complication of total hip arthroplasty (THA), may be linked to increased cardiovascular disease (CVD) risk.
- Understanding this association is crucial for long-term patient management after THA.
Purpose of the Study:
- To investigate the long-term CVD risk in THA patients with asymptomatic periacetabular osteolysis compared to those without.
- To assess the time to CVD events and compare cardiovascular risk markers between groups.
Main Methods:
- Retrospective cohort study of 139 patients undergoing uncemented THA (1992-2007).
- Patients were categorized into groups with and without periacetabular osteolysis using computed tomography.
- Kaplan-Meier and Cox regression analyses were used to evaluate time to event and hazard ratios.
Main Results:
- A higher relative incidence of CVD was observed in patients with periacetabular osteolysis (24%) compared to those without (8%).
- Mean follow-up was 16.6 years; 11% of patients developed CVD.
- No significant differences in cardiovascular risk markers or ECG abnormalities were found between groups.
Conclusions:
- The study found no direct association between periacetabular osteolysis and specific CVD risk markers.
- A trend suggests a potential increased long-term CVD risk associated with periacetabular osteolysis following THA.
- Low-grade peri-implant inflammation warrants further investigation as a potential contributor to increased CVD risk.
Background And Purpose:
A clinical problem in total hip arthroplasty (THA) is periprosthetic osteolysis/aseptic loosening. There is a possible association between periprosthetic osteolysis and higher risk of cardiovascular disease (CVD). The aim of this study was to investigate whether THA patients with asymptomatic periacetabular osteolysis, have an increased long-term risk of CVD compared to THA patients without osteolysis, assess time to the event, and compare possible cardiovascular risk markers between the two groups.
Patients And Methods:
We conducted a retrospective cohort study of 139 patients treated with uncemented THA between 1992 and 2007. All patients were assessed by computed tomography of the affected hip to sort patients in one group with osteolysis and one without. The statistical analysis was based on descriptive statistics. The Kaplan-Meier method was used to estimate time to event and Cox regression models were fitted to calculate crude and adjusted hazard ratios (HR) with 95% confidence intervals (95% CI).
Results:
There were 33 patients with periacetabular osteolysis and 106 patients without. Mean follow-up time was 16.6 years (range, 12-30). 16 patients (11%) were diagnosed with CVD after a mean (SD) of 14 (6) years, with a higher relative incidence 8/33 (24%) vs 8/106 (8%) of CVD among patients with periacetabular osteolysis. The hazard ratio was 1.6, 95% confidence interval (0.4-5.8). There were no differences in presence of cardiovascular risk markers or ECG abnormalities.
Interpretation:
We found no association between periacetabular osteolysis and possible risk markers for CVD. There was a trend towards higher incidence of CVD among patients with periacetabular osteolysis. Based on the results from our relatively small cohort it cannot be excluded that low-grade peri-implant inflammation may increase long term risk of CVD following THA.
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