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NSAIDs can raise risk of aseptic loosening in uncemented total hip arthroplasty
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WASHINGTON — Nonsteroidal anti-inflammatory drugs increased the risk of revision due to aseptic loosening among patients with uncemented total hip arthroplasty, according to data from the Danish Hip Arthroplasty Register. Patients undergoing cemented arthroplasty saw no such increase.
Per Kjaersgaard-Andersen, MD, of Vejle Hospital in Vejle, Denmark, and colleagues analyzed 46,844 total hip replacement operations performed in Denmark between 1995 and 2003. Of these, 24,496 were cemented, 9,050 were uncemented and 13,298 were hybrid implants. A total of 7518 patients received NSAIDs for at least one week in the early postoperative period, primarily to prevent heterotopic ossification.
Using multivariate regression analyses, researchers found an almost three-fold increase in revision risk due to aseptic loosening in patients who received uncemented implants and NSAIDs (RR=2.93; 95% CI: 1.30-6.60). This contrasted sharply with the patients who received cemented implants, for whom NSAIDs seemed to have a protective effect. The data on this protective effect did not, however, reach statistical significance (RR=0.76; 95% CI: 0.56-1.03).
Younger patients at risk
"The risk of being revised due to aseptic loosening for all ages [was about] 3.0. But if you take a specific look at the younger generation, there is a 10-fold increase [in risk] compared to the mean. They are really at high risk of having aseptic loosening if treated with these drugs," he said. Kjaersgaard-Andersen, a member of the Orthopaedics Today Editorial Advisory Board, presented his results at the American Academy of Orthopaedic Surgeons 72nd Annual Meeting in Washington.
Comparing loosening rates for femoral stems vs. acetabular cups, researchers found the problem of increased risk to be stem-related. They saw no difference between uncemented and cemented acetabular component loosening, but they did uncover an increase in loosening on the femoral side.
"We know this is register data, and [there are] limitations when you present data from a register, but the take-home message should be to beware of using antiinflammatory medication with the use of uncemented implants, especially in the younger generation, as it may increase your aseptic loosening rate," Kjaersgaard-Andersen said. He noted that the cutoff point for younger age was 55 years.
For more information:
- Kjaersgaard-Andersen P, Johnsen SP, Riis A, et al. Aseptic loosening of noncemented total hip arthroplasty after treatment with NSAIDs. #317.Presented at the American Academy of Orthopaedic Surgeons 72nd Annual Meeting. Feb. 23-27, 2005. Washington.