Use of medications and risk of revision after primary total hip arthroplasty

Figures & data

Figure 1. Total hip arthroplasty

Figure 2. Expected incidence rates (IRs) of primary THAs in Denmark in the years 2010, 2015, and 2020, based on constant age-specific IRs of primary THAs (2002) A: with expected changes in age distribution, B: with expected changes in age distribution combined with the continued annual age and sex-specific increase in the standardized IRs of primary THA based on figures from 1996–2002 (Pedersen et al. 2005).

Figure 3. Factors determining the prognosis following primary THA.

Figure 4. Pleiotropic effects of statins that may influence implant survival.

Figure 5. Linkage of nationwide registers using the personal identification number.

Table 1. Crude and adjusted relative risk for revision after primary THA according to postoperative statin use

Duration of statin treatment	Crude RR	Adjusted RR^a	Statin users (n)
< 1 year	0.45 (0.33–0.61)	0.42 (0.30–0.59)	220
1–2 years	0.29 (0.20–0.44)	0.34 (0.28–0.41)	160
2–3 years	0.19 (0.11–0.33)	0.16 (0.09–0.30)	98
> 3 years	0.41 (0.30–0.56)	0.36 (0.26–0.50)	208

^a Adjusted for age, gender, fixation technique, co-morbidity, and indication for primary THA

Table 2. Crude and adjusted RR for revision due to all causes and specific indications for revision in patients redeeming at least 1 statin prescription in the postoperative period

Revision due to	Crude RR	Adjusted RR ^a	Cases (n)	Controls (n)
All causes	0.34 (0.28–0.41)	0.34 (0.28–0.41)	2349	2349
Deep infection	0.27 (0.16–0.46)	0.29 (0.17–0.50)	367	367
Aseptic loosening	0.44 (0.32–0.58)	0.38 (0.28–0.53)	819	819
Dislocation	0.28 (0.20–0.40)	0.28 (0.20–0.40)	812	812
Periprosthetic fracture	0.16 (0.06–0.41)	0.12 (0.04–0.33)	105	105
Pain	0.70 (0.26–1.80)	0.91 (0.24–3.45)	179	179
Implant failure	0.38 (0.14–1.08)	0.35 (0.08–1.44)	62	62
Other reasons ^b	0.35 (0.14–0.83)	0.30 (0.14–0.99)	106	106

^a Adjusted for sex, age, fixation technique, co-morbidity and diagnosis for primary THA

^b Other reasons include: anisomelia, ectopic bone formation, and technical problems

Table 3. Adjusted RR for specific indications for revision in patients redeeming at least one diuretic prescription in the period postoperative period divided into thiazid and loop diuretics

Revision due to	Cases (n)	Controls (n)	Thiazid diuretics Adjusted RR ^a (95% CI)	Loop diuretics Adjusted RR ^a (95% CI)
All causes	2491	4943	0.98 (0.85–1.12)	1.14 (0.98–1.32)
Deep infection	398	789	0.90 (0.62–1.31)	1.71 (1.15–2.55)
Aseptic loosening	856	1687	1.00 (0.80–1.25)	0.82 (0.60–1.11)
Dislocation	872	1735	0.96 (0.74–1.25)	1.15 (0.87–1.53)
Periprosthetic fracture	117	233	2.14 (0.69–6.60)	6.39 (1.84–22.2)
Miscellaneous ^b	265	492	1.79 (1.00–3.17)	1.86 (0.93–3.70)

^a Adjusted for gender, age, family status, educational level, gross income, county of residence, platelet inhibitor use, warfarin use, ACE inhibitor/ATII antagonist use, beta blocker use, anti arrhythmic use, statin use, topical corticosteroid use, systemic corticosteroid use, insulin use, oral anti-diabetic use, NSAID use, hormone replacement therapy, myocardial infarction, congestive heart failure, peripheral vascular disease, cerebrovascular disease, dementia, chronic pulmonary disease, connective tissue disease, ulcer disease, liver disease, diabetes I and II, diabetes with organ disability, hemiplegia, renal disease, cancer, year of primary THA surgery, implant fixation technique, and diagnosis for primary THA. Further, we adjusted mutually for use of thiazid and loop diuretics, respectively.

^b Miscellaneous includes: pain, implant failure, anisomelia, ectopic bone formation, and technical problems.

Table 4. Adjusted Relative Risk (RR) following primary THA for specific indications for revision in patients redeeming at least one prescription of bisphosphonates in the postoperative period

Revision due to	Cases (n)	Controls (n)	Crude RR	Adjusted RR ^a
All causes	632	1264	1.14 (0.83–1.57)	1.34 (0.93–1.93)
Deep infection	100	300	2.05 (1.00–4.21)	2.59 (1.30–6.53)
Aseptic loosening	160	320	1.00 (0.53–1.89)	1.35 (0.43–2.86)
Dislocation	256	512	1.20 (0.72–1.99)	1.50 (0.83–2.69)

^a Adjusted for region of residence, use of statins, use of corticosteroids, diabetes I and II, year of primary THA, diagnosis for primary THA, and diagnosis for inclusion in the study.

Pedersen AB, Johnsen SP, Overgaard S, Soballe K, Sorensen HT, Lucht U. Total hip arthroplasty in Denmark: incidence of primary operations and revisions during 1996-2002 and estimated future demands. Acta Orthop 2005; 76(2):182-189.

 PubMedGoogle Scholar