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NSAID use in first year after THA may be linked to increased revision rate
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NEW ORLEANS — The use of NSAIDs can help predict the likelihood of revision total hip arthroplasty if its use occurs within the first year after surgery, according to results of a study presented at the American Academy of Orthopaedic Surgeons Annual Meeting.
The researchers used patient data from the Catalan Joint Registry cohort that was highly linked to primary care records and pharmacy invoice data, as well as other databases, to provide what the investigators described as good data on pharmaceutical use, comorbidities, socioeconomic status and lifestyle factors. With these data, Tamer T. Malak, BM, MRCS, DipME, FHEA, and Antony J.R. Palmer, MA, BMBCh, of Oxford, United Kingdom, Mireia Espallargues-Carreras, MPH, MD, of Barcelona, and colleagues undertook a retrospective cohort study of 11,886 patients who underwent primary total hip arthroplasty (THA) from 2005 to 2012.
They excluded 4,955 patients because they received resurfacing, uni/mono-block, unimodular, bipolar, tripolar or short-stem implants.
Multivariate models used
Researchers defined NSAID use with the World Health Organization ATC/DDD index daily defined doses and further categorized it into quintiles. Factors that Malak and colleagues included in the multivariate analysis were age, gender, body mass index, alcohol use, smoking status, comorbidities, socioeconomic status and type of THA fixation.
“There was a high level of NSAID intake in this population,” Palmer said during the presentation.
The results of a survival analysis showed NSAID use within the first year postoperatively was associated with an increased incidence of revision.
More revisions in men
“The overall revision rate was 1.1% during this time,” Palmer said. The subdistribution hazard ratio (SHR) was 1.23 per quintile. Patients with THA in the top quintile vs. those in the lowest quintile corresponded to an adjusted SHR of 1.82 and Malak and colleagues found the strongest association with revision in men and patients greater than 72 years old.
“We also looked at NSAID usage in the year pre-total hip replacement and the year after total hip replacement to see whether the change was important,” Palmer said. “But actually the hazard ratios were slightly low for that. It seems to be the absolute dose that has the strongest correlation with implant failure.”
The researchers said they were uncertain whether or not NSAIDs increased the risk of THA failure by impeding osteointegration. In a subgroup analysis looking at cemented vs. uncemented, Malak and colleagues found no difference between the two groups.
“The important things are the data linkage is offering potential icons for early implant failure and it may be that we have [patient-reported outcome measures] PROMs data, we have analgesic use and other factors that will predict early failure sooner than registry data would. More importantly, this is data that has already been collected from a primary care setting and would not involve any further interaction,” Palmer said. – by Christian Ingram
- Reference:
- Malak T. Paper #12. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 11-15, 2014; New Orleans.
- For more information:
- Tamer T. Malak, BM, MRCS, DipME, FHEA, can be reached at Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Oxford, OX3 7LD, England; email: tamar.malak@ndorms.ox.ac.uk.
Disclosures: Malak and Palmer have no relevant financial disclosures.