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。超过7百万 美国人目前生活在人工髋关节或膝关节，这是预计将达到流行病 由于对改善流动性和生活质量的需求日益增长，虽然 TJA是一种相对安全的手术，人们越来越担心长期的系统性 长期暴露于TJA植入物的影响。事实上，在越来越多的公开案例中， 据报道，TJA患者在手术后几年出现心脏毒性和心力衰竭。 然而，风险的机制和程度尚不清楚。规模大，人口多- 需要进行基础研究，以评估长期暴露于TJA的潜在贡献 植入物碎片和亚型（钴/铬、聚乙烯）对心脏毒性的风险， 心衰我们建议利用独特的人口数据资源和马约 临床TJA注册研究TJA患者的心脏毒性。 使用REP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， 已知的混淆因素。我们将根据植入物类型进一步检查风险。我们将 检索历史超声心动图数据，以比较心脏结构和功能指标 TJA患者和对照组。最后，我们将把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朝着以下目标迈出的关键一步： 了解长期暴露于TJA植入物是否对心脏有不良影响。我们 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。潜在 下游影响显著，包括监测高风险TJA植入物和患者 他们最有可能受到全身心脏影响。

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.