Rodnell Busigó Torres, James Hong, Hanish Kodali, Jashvant Poeran, Brocha Z Stern, Brett L Hayden, Darwin D Chen, Calin S Moucha
{"title":"术前使用双膦酸盐会影响全髋关节置换术后假体周围骨折的风险吗？","authors":"Rodnell Busigó Torres, James Hong, Hanish Kodali, Jashvant Poeran, Brocha Z Stern, Brett L Hayden, Darwin D Chen, Calin S Moucha","doi":"10.1016/j.arth.2024.08.043","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Bisphosphonate (BP) use is not uncommon among total hip arthroplasty (THA) candidates. While the impact of BP therapy post-THA has been investigated, there is a paucity of literature discussing the impact of BP therapy pre-THA. Using a national dataset, we aimed to study the association between preoperative BP use and surgical outcomes in primary THA recipients.</p><p><strong>Methods: </strong>This retrospective cohort study utilized a commercial claims and Medicare Supplemental Databases to identify adults aged ≥ 18 who had an index non-fracture-related primary THA from 2016 to 2020. The use of BP was defined as ≥ 6 months of BP therapy in the year prior to THA. Outcomes were 90-day all-cause readmission, 90-day readmission related to periprosthetic fracture (PPF), 90-day and 1-year all-cause revision, 1-year PPF-related revision, and 1-year diagnosis of PPF. In a 1:5 propensity-score matched analysis, each THA patient who had preoperative BP use was matched to five THA patients who did not have preoperative BP use. Logistic regression models were fitted; we report odds ratios (OR) and 95% confidence intervals (CI).</p><p><strong>Results: </strong>Of 91,907 THA patients, 1,018 (1.1%) used BP preoperatively. In the propensity-score-matched cohort (1,018 preoperative BP users, 5,090 controls), preoperative BP use was significantly associated with increased odds of 90-day all-cause revision surgery (OR 1.67; 95% CI 1.10 to 2.53; P = 0.02), 1-year PPF-related revision (OR 2.23; 95% CI 1.21 to 4.10; P = 0.01), and 1-year PPF diagnosis (OR 1.88; 95% CI 1.10 to 3.20; P = 0.02). There was no significant association between preoperative BP use and the other outcomes in the matched cohort.</p><p><strong>Conclusion: </strong>These findings suggest that preoperative BP use is associated with an increased risk of revision surgery and PPF in both the short and long term. This information can help in preoperative planning and patient counseling, potentially leading to improved surgical outcomes and reduced complication rates.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":null,"pages":null},"PeriodicalIF":3.4000,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Does Preoperative Bisphosphonate Use Impact the Risk of Periprosthetic Fracture Following Total Hip Arthroplasty?\",\"authors\":\"Rodnell Busigó Torres, James Hong, Hanish Kodali, Jashvant Poeran, Brocha Z Stern, Brett L Hayden, Darwin D Chen, Calin S Moucha\",\"doi\":\"10.1016/j.arth.2024.08.043\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Bisphosphonate (BP) use is not uncommon among total hip arthroplasty (THA) candidates. While the impact of BP therapy post-THA has been investigated, there is a paucity of literature discussing the impact of BP therapy pre-THA. Using a national dataset, we aimed to study the association between preoperative BP use and surgical outcomes in primary THA recipients.</p><p><strong>Methods: </strong>This retrospective cohort study utilized a commercial claims and Medicare Supplemental Databases to identify adults aged ≥ 18 who had an index non-fracture-related primary THA from 2016 to 2020. The use of BP was defined as ≥ 6 months of BP therapy in the year prior to THA. Outcomes were 90-day all-cause readmission, 90-day readmission related to periprosthetic fracture (PPF), 90-day and 1-year all-cause revision, 1-year PPF-related revision, and 1-year diagnosis of PPF. In a 1:5 propensity-score matched analysis, each THA patient who had preoperative BP use was matched to five THA patients who did not have preoperative BP use. Logistic regression models were fitted; we report odds ratios (OR) and 95% confidence intervals (CI).</p><p><strong>Results: </strong>Of 91,907 THA patients, 1,018 (1.1%) used BP preoperatively. In the propensity-score-matched cohort (1,018 preoperative BP users, 5,090 controls), preoperative BP use was significantly associated with increased odds of 90-day all-cause revision surgery (OR 1.67; 95% CI 1.10 to 2.53; P = 0.02), 1-year PPF-related revision (OR 2.23; 95% CI 1.21 to 4.10; P = 0.01), and 1-year PPF diagnosis (OR 1.88; 95% CI 1.10 to 3.20; P = 0.02). There was no significant association between preoperative BP use and the other outcomes in the matched cohort.</p><p><strong>Conclusion: </strong>These findings suggest that preoperative BP use is associated with an increased risk of revision surgery and PPF in both the short and long term. 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引用次数: 0
摘要
简介：在全髋关节置换术（THA）患者中，使用双膦酸盐（BP）并不少见。虽然已经研究了全髋关节置换术后 BP 治疗的影响，但很少有文献讨论全髋关节置换术前 BP 治疗的影响。我们利用一个全国性数据集，旨在研究初级髋关节置换术受术者术前服用降压药与手术效果之间的关系：这项回顾性队列研究利用商业索赔数据库和医疗保险补充数据库，对 2016 年至 2020 年期间年龄≥ 18 岁、接受非骨折相关初次 THA 的成年人进行识别。使用降压药的定义是在 THA 之前的一年中接受降压治疗的时间≥ 6 个月。研究结果包括 90 天全因再入院、90 天假体周围骨折 (PPF) 相关再入院、90 天和 1 年全因翻修、1 年 PPF 相关翻修以及 1 年 PPF 诊断。在 1:5 的倾向得分匹配分析中，每位术前服用过降压药的 THA 患者与五位术前未服用降压药的 THA 患者进行匹配。我们拟合了逻辑回归模型，并报告了几率比（OR）和 95% 的置信区间（CI）：在 91,907 名 THA 患者中，有 1,018 人（1.1%）在术前使用过降压药。在倾向分数匹配队列（1,018 名术前服用降压药者，5,090 名对照组）中，术前服用降压药与 90 天全因翻修手术几率增加显著相关（OR 1.67; 95% CI 1.10 to 2.53; P = 0.02）、1 年 PPF 相关翻修（OR 2.23; 95% CI 1.21 to 4.10; P = 0.01）和 1 年 PPF 诊断（OR 1.88; 95% CI 1.10 to 3.20; P = 0.02）显著相关。在匹配队列中，术前服用降压药与其他结果之间没有明显关联：这些研究结果表明，从短期和长期来看，术前服用降压药与翻修手术和 PPF 风险的增加有关。这些信息有助于术前规划和患者咨询，从而改善手术效果并降低并发症发生率。
Does Preoperative Bisphosphonate Use Impact the Risk of Periprosthetic Fracture Following Total Hip Arthroplasty?
Introduction: Bisphosphonate (BP) use is not uncommon among total hip arthroplasty (THA) candidates. While the impact of BP therapy post-THA has been investigated, there is a paucity of literature discussing the impact of BP therapy pre-THA. Using a national dataset, we aimed to study the association between preoperative BP use and surgical outcomes in primary THA recipients.
Methods: This retrospective cohort study utilized a commercial claims and Medicare Supplemental Databases to identify adults aged ≥ 18 who had an index non-fracture-related primary THA from 2016 to 2020. The use of BP was defined as ≥ 6 months of BP therapy in the year prior to THA. Outcomes were 90-day all-cause readmission, 90-day readmission related to periprosthetic fracture (PPF), 90-day and 1-year all-cause revision, 1-year PPF-related revision, and 1-year diagnosis of PPF. In a 1:5 propensity-score matched analysis, each THA patient who had preoperative BP use was matched to five THA patients who did not have preoperative BP use. Logistic regression models were fitted; we report odds ratios (OR) and 95% confidence intervals (CI).
Results: Of 91,907 THA patients, 1,018 (1.1%) used BP preoperatively. In the propensity-score-matched cohort (1,018 preoperative BP users, 5,090 controls), preoperative BP use was significantly associated with increased odds of 90-day all-cause revision surgery (OR 1.67; 95% CI 1.10 to 2.53; P = 0.02), 1-year PPF-related revision (OR 2.23; 95% CI 1.21 to 4.10; P = 0.01), and 1-year PPF diagnosis (OR 1.88; 95% CI 1.10 to 3.20; P = 0.02). There was no significant association between preoperative BP use and the other outcomes in the matched cohort.
Conclusion: These findings suggest that preoperative BP use is associated with an increased risk of revision surgery and PPF in both the short and long term. This information can help in preoperative planning and patient counseling, potentially leading to improved surgical outcomes and reduced complication rates.
期刊介绍：
The Journal of Arthroplasty brings together the clinical and scientific foundations for joint replacement. This peer-reviewed journal publishes original research and manuscripts of the highest quality from all areas relating to joint replacement or the treatment of its complications, including those dealing with clinical series and experience, prosthetic design, biomechanics, biomaterials, metallurgy, biologic response to arthroplasty materials in vivo and in vitro.
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