Oral Bisphosphonate Use and Total Knee/Hip Implant Survival Validation of Results in an External Population-Based Cohort
Oral Bisphosphonate Use and Total Knee/Hip Implant Survival Validation of Results in an External Population-Based Cohort
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DOI：
10.1002/art.38789
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发表时间：
2014-11-01
影响因子：
13.3
通讯作者：
de Vries, Frank
中科院分区：
文献类型：
--
作者：
Prieto-Alhambra, Daniel;Lalmohamed, Arief;de Vries, Frank
目标。无菌性松动是关节置换术最常见的原因。双膦酸盐可以通过其抗吸收作用来减少这种情况。本研究旨在探讨双膦酸盐的使用与种植体存活之间的关系。一项回顾性队列研究在丹麦全国登记（550万居民）中进行。使用国际疾病和相关健康问题统计分类第十版的程序代码，我们确定了1998-2007年间年龄bb0 = 40岁接受全关节置换术的患者。我们排除了使用改善疾病的抗风湿药物以及类风湿关节炎、佩吉特病或髋部骨折的患者。如果参与者接受治疗超过6个月，则被归类为双膦酸盐使用者。采用时变曝光避免了不灭时间偏差。使用倾向评分，最多6名接受关节置换的非双膦酸盐使用者与每个双膦酸盐使用者相匹配。根据双膦酸盐的使用，采用分层Cox回归来模拟种植体的存活。此外，我们研究了植入物存活与使用时间、依从性（药物持有率）和治疗开始时间（术前/术后）的关系。在95,392例原发性全关节置换术患者中，80,342例（84.2%）符合条件。我们确定了1590名双膦酸盐使用者（2.0%），其中1558名（98.0%）与8966名双膦酸盐非使用者相匹配。1558名双膦酸盐使用者中的27名（1.73%）和8966名匹配的非使用者中的399名（4.45%）在研究随访期间接受了翻修手术（第一次手术后的中位时间为2.61年[四分位数间距1.04-5.41年]）。Cox回归显示，双膦酸盐使用者翻修手术的风险降低（风险比0.41[95%可信区间0.27-0.61]）。这种相关性在治疗时间最长和/或依从性最好的患者中最强。口服双膦酸盐使用者进行翻修手术的风险降低了59%。这种关联仅在关节置换术后开始使用双膦酸盐时出现。迫切需要随机对照试验的证实。
Objective. Aseptic loosening is the most common cause of revision arthroplasty. Bisphosphonates could minimize this through their antiresorptive effects. This study was undertaken to investigate the association between bisphosphonate use and implant survival.Methods. A retrospective cohort study was conducted within the Danish nationwide registries (5.5 million residents). Using procedure codes of the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, we identified patients age >= 40 years undergoing total joint replacement in 1998-2007. We excluded users of disease-modifying antirheumatic drugs as well as patients with rheumatoid arthritis, Paget's disease, or hip fracture. Participants were classified as bisphosphonate users if they had been receiving treatment for >= 6 months. A time-varying exposure was used to avoid immortal time bias. Up to 6 bisphosphonate nonusers undergoing arthroplasty were matched to each bisphosphonate user, using propensity scores. Stratified Cox regression was performed to model implant survival according to bisphosphonate use. Further, we studied the associations of implant survival with duration of use, adherence (medication possession ratio), and timing of therapy initiation (preoperative/postoperative).Results. Of 95,392 patients with a primary total joint replacement, 80,342 (84.2%) were eligible. We identified 1,590 bisphosphonate users (2.0%), and 1,558 of them (98.0%) were matched to 8,966 bisphosphonate nonusers. Twenty-seven of the 1,558 bisphosphonate users (1.73%) and 399 of the 8,966 matched nonusers (4.45%) underwent revision surgery during the study followup period (at a median 2.61 years after the first surgery [interquartile range 1.04-5.41 years]). Cox regression showed a reduced risk of revision surgery in bisphosphonate users (hazard ratio 0.41 [95% confidence interval 0.27-0.61]). This association was strongest in patients with the longest duration of treatment and/or the best adherence.Conclusion. Oral bisphosphonate users have a 59% reduced risk of revision surgery. This association is only present when bisphosphonates are started after arthroplasty surgery. Confirmation in randomized controlled trials is urgently needed.