Increased Long-Term Cardiovascular Risk After Total Hip Arthroplasty

Total hip arthroplasty is a common and important treatment for osteoarthritis patients. Long-term cardiovascular effects elicited by osteoarthritis or the implant itself remain unknown. The purpose of the present study was to determine if there is an increased risk of late cardiovascular mortality and morbidity after total hip arthroplasty surgery. A nationwide matched cohort study with data on 91,527 osteoarthritis patients operated on, obtained from the Swedish Hip Arthroplasty Register. A control cohort (n1⁄4 270,688) from the general Swedish population was matched 1:3 to each case by sex, age, and residence. Mean follow-up time was 10 years (range, 7–21). The exposure was presence of a hip replacement for more than 5 years. The primary outcome was cardiovascular mortality after 5 years. Secondary outcomes were total mortality and re-admissions due to cardiovascular events. During the first 5 to 9 years, the arthroplasty cohort had a lower cardiovascular mortality risk compared with the control cohort. However, the risk in the arthroplasty cohort increased over time and was D, PhD, Göran G PhD, , PhD, and Olof Sköldenberg, MD, PhD frequently admitted to hospital for cardiovascular reasons compared with controls, with a rate ratio of 1.08 (95% CI 1.06–1.11). Patients with surgically treated osteoarthritis of the hip have an increased risk of cardiovascular morbidity and mortality many years after the operation when compared with controls. (Medicine 95(6):e2662) Abbreviations: CDR = Cause of Death Register, CI = confidence interval, HR = hazard ratio, NPR = Swedish National Patient Register, NSAID = nonsteroidal anti-inflammatory drugs, OPG = osteoprotegerin, RANKL = receptor activator of nuclear factor k B ligand, RANKL = receptor activator of nuclear factor k B ligand, RR = rate ratio, SHAR = Swedish Hip Arthroplasty Register. INTRODUCTION T he pathogenesis of cardiovascular disease is causally related to inflammatory processes. Conditions associated with inflammatoryactivity suchasrheumatoidarthritis orpoordental health increase the risk of cardiovascular events. Parallel with these insights, primary osteoarthritis has moved from being perceived as a wear-and-tear condition to an inflammatory disease. Moreover, the most common treatment modality for symptomatic osteoarthritis is joint replacement, a surgical procedure that by itself induces inflammation. It is unknown how osteoarthritis and its surgical treatment impact the cardiovascular system. Worldwide more than 1 million patients receive a total hip arthroplasty for osteoarthritis every year and, compared with other common joint replacements, it is associated with a high incidence of long-term inflammatory foreign-body tissue reactions. In the early phase after total hip arthroplasty surgery, mortality is increased when compared with the general population, but this is later followed by a reduced mortality in arthroplasty patients. The longest hitherto published follow-up of mortality after total hip arthroplasty is for <13 years, but long-term cardiovascular mortality and morbidity have not been investigated beyond this period. The aim of this study was to determine if there is a late correlation between total hip arthroplasty and cardiovascular events. We hypothesized that total hip arthroplasty patients more than 5 years after index recorded surgery have an increased risk for cardiovascular morbidity and mortality compared with the general population.