Cardiotoxicity in Total Joint Arthroplasty

摘要 全关节置换术(TJA)是美国发展最快的择期手术。700多万 美国人目前生活在人工髋关节或膝关节，预计这将达到流行病 这是由于对提高机动性和生活质量的需求日益增长所致。虽然 TJA是一种相对安全的手术，有越来越多的人关注长期全身性 长期接触TJA植入物的影响。事实上，在越来越多已发表案例中 报道称，TJA患者在手术后几年出现心脏毒性和心力衰竭。 然而，这种风险的机制和程度尚不清楚。规模大，人口多- 需要基础研究来评估慢性暴露于TJA的潜在贡献 植入碎片和亚型(钴/铬、聚乙烯)以增加心脏毒性和 心力衰竭。我们建议利用独特的基于人口的数据资源和Mayo 临床TJA登记，以调查TJA患者的心脏毒性。 使用来自该代表的50年历史数据，我们将比较 TJA患者和匹配的非TJA受试者的基于人群的队列调整 已知的混杂因素。我们将根据植入物的类型进一步检查风险。我们会 检索历史超声心动图数据以比较心脏结构和功能测量 在TJA患者和对照组中。最后，我们将金属离子水平与横截面和 TJA患者的纵向心脏结构和功能测量。 成功完成拟议的一系列研究将是实现以下目标的关键步骤 了解长期接触TJA植入物是否会对心脏产生不利影响。我们的 独特的数据资源为有效应对这一未知风险提供了难得的机会。潜力 下游影响显著，包括监测高危TJA植入物和患者 他们最有可能遭受全身心脏影响。

ABSTRACT Total joint arthroplasty (TJA) is the fastest growing elective surgery in the nation. Over 7 million Americans are currently living artificial hip or knee joints and this is expected to reach epidemic proportions as a result of growing demand for improved mobility and quality of life. Although TJA is a relatively safe procedure, there is growing concern about the long-term systemic effects of chronic exposure to TJA implants. Indeed, in a growing number of published case reports, TJA patients present with cardiotoxicity and heart failure several years after surgery. Yet, the mechanisms and the magnitude of the risk are unknown. Large scale, population- based studies are needed to assess the potential contribution of chronic exposure to TJA implant debris and subtypes (cobalt/chromium, polyethylene) to the risk of cardiotoxicity and heart failure. We propose to leverage unique population-based data resources and the Mayo Clinic TJA registry to investigate cardiotoxicity in TJA patients. Using 5-decades of historical data from the REP, we will compare the risk of heart failure in population-based cohorts of TJA patients and matched non-TJA subjects adjusting for well- known confounders. We will further examine the risk according to implant types. We will retrieve historical echocardiographic data to compare cardiac structure and function measures in TJA patients and controls. Finally, we will correlate metal ion levels with cross-sectional and longitudinal cardiac structure and function measures in TJA patients. Successful completion of the proposed series of studies will be a key step towards understanding whether chronic exposure to TJA implants has adverse cardiac effects. Our unique data resources offer a rare opportunity to efficiently address this unknown risk. Potential downstream effects are significant including monitoring of high risk TJA implants and patients who are most likely to suffer from systemic cardiac effects.