| アブストラクト | OBJECTIVE: To identify patients at risk of mid-late term revision of hip replacement to inform targeted follow-up. DESIGN: Analysis of linked national data sets from primary and secondary care (Clinical Practice Research Datalink (CPRD-GOLD); National Joint Registry (NJR); English Hospital Episode Statistics (HES); Patient-Reported Outcome Measures (PROMs)). PARTICIPANTS: Primary elective total hip replacement (THR) aged>/=18. EVENT OF INTEREST: Revision surgery>/=5 years (mid-late term) after primary THR. STATISTICAL METHODS: Cox regression modelling to ascertain risk factors of mid-late term revision. HR and 95% CI assessed association of sociodemographic factors, comorbidities, medication, surgical variables and PROMs with mid-late term revision. RESULTS: NJR-HES-PROMs data were available from 2008 to 2011 on 142 275 THR; mean age 70.0 years and 61.9% female. CPRD GOLD-HES data covered 1995-2011 on 17 047 THR; mean age 68.4 years, 61.8% female. Patients had minimum 5 years postprimary surgery to end 2016. In NJR-HES-PROMS data, there were 3582 (2.5%) revisions, median time-to-revision after primary surgery 1.9 years (range 0.01-8.7), with 598 (0.4%) mid-late term revisions; in CPRD GOLD, 982 (5.8%) revisions, median time-to-revision 5.3 years (range 0-20), with 520 (3.1%) mid-late term revisions.Reduced risk of mid-late term revision was associated with older age at primary surgery (HR: 0.96; 95% CI: 0.95 to 0.96); better 6-month postoperative pain/function scores (HR: 0.35; 95% CI: 0.27 to 0.46); use of ceramic-on-ceramic (HR: 0.73; 95% CI: 0.56 to 0.95) or ceramic-on-polyethylene (HR: 0.76; 95% CI: 0.58 to 1.00) bearing surfaces.Increased risk of mid-late term revision was associated with the use of antidepressants (HR: 1.32; 95% CI: 1.09 to 1.59), glucocorticoid injections (HR: 1.33; 95% CI: 1.06 to 1.67) and femoral head size>/=44 mm (HR: 2.56; 95% CI: 1.09 to 6.02)No association of gender, obesity or Index of Multiple Deprivation was observed. CONCLUSION: The risk of mid-late term THR is associated with age at primary surgery, 6-month postoperative pain and function and implant factors. Further work is needed to explore the associations with prescription medications observed in our data. |
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| ジャーナル名 | BMJ open |
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| 投稿日 | 2022/3/11 |
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| 投稿者 | Smith, Lindsay K; Garriga, Cesar; Kingsbury, Sarah R; Pinedo-Villanueva, Rafael; Delmestri, Antonella; Arden, Nigel K; Stone, Martin; Conaghan, Philip G; Judge, Andrew |
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| 組織名 | Faculty of Health and Applied Sciences, University of the West of England,;Bristol, Bristol, UK lindsay.smith2@nhs.net.;Trauma and Orthopaedics, University Hospitals Bristol and Weston NHS Foundation;Trust, Bristol, Bristol, UK.;Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences,;University of Oxford, Oxford, UK.;Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds,;Leeds, UK.;NIHR Leeds Biomedical Research Centre, Leeds, UK.;Orthopaedics Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK.;Translational Health Sciences, Bristol Medical School, University of Bristol,;Bristol, UK. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/35264338/ |
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