title: Increased Long-Term Cardiovascular Risk After Total Hip Arthroplasty: A Nationwide Cohort Study.
abstract: 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 (n = 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 higher than in controls after 8.8 years (95% confidence interval [CI] 7.0-10.5). Between 9 and 13 years postoperatively, the hazard ratio was 1.11 (95% CI 1.05-1.17). Arthroplasty patients were also more 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.
authors.affiliation: From the Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden (MG, AR, SA, TE, AS, OS); Department of Orthopedics, Institute of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden (AG, NH); Swedish Hip Arthroplasty Register, Registercentrum VGR, Gothenburg, Sweden (OR, GG); Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (OR, GG); and Harris Orthopedic Laboratory, Massachusetts General Hospital and Harvard Medical School (OR), Boston, MA.
authors.forename: Max
authors.initials: M
authors.lastname: Gordon
authors.forename: Agata
authors.initials: A
authors.lastname: Rysinska
authors.forename: Anne
authors.initials: A
authors.lastname: Garland
authors.forename: Ola
authors.initials: O
authors.lastname: Rolfson
authors.forename: Sara
authors.initials: S
authors.lastname: Aspberg
authors.forename: Thomas
authors.initials: T
authors.lastname: Eisler
authors.forename: Göran
authors.initials: G
authors.lastname: Garellick
authors.forename: André
authors.initials: A
authors.lastname: Stark
authors.forename: Nils P
authors.initials: NP
authors.lastname: Hailer
authors.forename: Olof
authors.initials: O
authors.lastname: Sköldenberg
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D015207:Osteoarthritis, Hip / Q000601:surgery; D012307:Risk Factors; D013548:Sweden; D013997:Time Factors