| アブストラクト | OBJECTIVE: Hyperlipidaemia is common in knee and hip replacement patients, with nearly half untreated. Elevated low-density lipoprotein cholesterol (LDL-C) has been associated with postoperative pain and prosthetic joint infections; however, the impact of LDL-C lowering on revision surgery remains unclear. We aimed to examine the association between pragmatic LDL-C management strategies, operationalized according to LDL-C target attainment during the 1-year grace period, and the risk of revision among patients with hyperlipidaemia undergoing knee and hip replacement. METHODS: Using The Health Improvement Network database, we identified knee and hip replacement patients with hyperlipidaemia aged 40 years or older initiating LDL-C-lowering medications. We emulated a hypothetical target trial to compare the 5-year revision risk between pragmatic LDL-C management strategies, with adherence to the goal-based strategy operationalized as having an LDL-C level <3 mmol/L during the 1-year grace period. RESULTS: Among 28,756 qualified participants, the 5-year revision risk was lower in those achieving the target LDL-C level (2.35%) compared to those not achieving it (2.76%), with a risk difference of -0.41% (95%CI: -0.72% to -0.09%), and a hazard ratio (HR) of 0.74 (95%CI: 0.61 to 0.90). For knee replacement revision, the 5-year risk difference was -0.47% (95%CI: -0.91% to -0.09%), with an HR of 0.69 (95%CI: 0.51 to 0.92). For hip replacement revision, the 5-year risk difference was -0.28% (95%CI: -0.80% to 0.20%), with an HR of 0.80 (95%CI: 0.63 to 1.01). CONCLUSION: Adherence to a goal-based LDL-C management strategy, operationalized as having an LDL-C level <3 mmol/L during the 1-year grace period, was associated with a lower risk of revision surgery among patients with hyperlipidaemia undergoing joint replacement, especially after knee replacement. THE TRANSLATIONAL POTENTIAL OF THIS ARTICLE: This study highlights postoperative lipid management as a potentially modifiable component of joint replacement care. If confirmed in future prospective studies, strategies to achieve guideline-recommended LDL-C targets may be considered as part of routine postoperative management to potentially improve long-term outcomes following joint replacement. |
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| 投稿者 | Li, Wei; Xiao, Yadan; Xie, Dongxing; Englund, Martin; Lane, Nancy E; Zhang, Yuqing; Wang, Yilun; Zhao, Kai; Wei, Jie; Lei, Guanghua; Zeng, Chao |
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| 組織名 | Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha,;China.;Department of Epidemiology and Health Statistics, Xiangya School of Public;Health, Central South University, Changsha, China.;Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital, Central;South University, Changsha, China.;Key Laboratory of Aging-related Bone and Joint Diseases Prevention and Treatment;of Ministry of Education, Xiangya Hospital, Central South University, Changsha,;Department of Clinical Sciences Lund, Orthopaedics, Clinical Epidemiology Unit,;Lund University, Lund, Sweden.;Center for Musculoskeletal Health and Department of Medicine, University of;California School of Medicine, Sacramento, CA, USA.;Division of Rheumatology, Allergy, and Immunology, Department of Medicine,;Massachusetts General Hospital, Harvard Medical School, Boston, USA.;The Mongan Institute, Massachusetts General Hospital, Harvard Medical School,;Boston, USA.;Department of Hematology and Critical Care Medicine, Third Xiangya Hospital,;Central South University, Changsha, China.;Key Laboratory of Sepsis Translational Medicine of Hunan, Central South;University, Changsha, China.;FuRong Laboratory, Changsha, Hunan, China.;National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, |
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