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Scientific Articles   |    
The Risk of Revision After Primary Total Hip Arthroplasty Among Statin UsersA Nationwide Population-Based Nested Case-Control Study
Theis M. Thillemann, MD1; Alma B. Pedersen, MD, PhD1; Frank Mehnert1; Søren P. Johnsen, MD, PhD1; Kjeld Søballe, MD, PhD1
1 Departments of Orthopedics (T.M.T. and K.S.) and Clinical Epidemiology (T.M.T., A.B.P., F.M., and S.P.J.), Aarhus University Hospital, Olof Palmes Allé 43-45, DK-8200 Aarhus N, Denmark. E-mail address for T.M. Thillemann: tt@dce.au.dk
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Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the Danish Rheumatism Association, the Augustinus Foundation, and the Korning Foundation. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

A commentary by Bassam A. Masri, MD, FRCSC, is available at www.jbjs.org/commentary and as supplemental material to the online version of this article.
Investigation performed at the Departments of Orthopedics and Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark

Copyright ©2010 American Society for Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2010 May 01;92(5):1063-1072. doi: 10.2106/JBJS.H.01805
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Abstract

Background: 

Statins have been associated with beneficial effects on bone metabolism and inflammation in both experimental and clinical studies. The association between statin use and the risk of revision after primary total hip arthroplasty has not been examined.

Methods: 

We identified 2349 patients from the Danish Hip Arthroplasty Registry who underwent revision of a primary total hip replacement in the period from 1996 to 2005 and matched them, using propensity score matching, with 2349 controls with a total hip replacement who had not had a revision. Using conditional logistic regression, we estimated the relative risk of revision due to all causes and due to specific causes according to postoperative statin use.

Results: 

The ten-year cumulative implant revision rate in the underlying cohort of 57,581 total hip arthroplasties from the registry was 8.9% (95% confidence interval, 8.4% to 9.4%). Postoperative statin use was associated with an adjusted relative risk of revision of 0.34 (95% confidence interval, 0.28 to 0.41) compared with no use of statin. Statin use was associated with a reduced risk of revision due to deep infection, aseptic loosening, dislocation, and periprosthetic fracture. No difference in the risk of revision due to pain or implant failure was found between statin users and nonusers.

Conclusions: 

The use of statins was associated with a substantially lower revision risk following primary total hip arthroplasty. Statins, however, should not be prescribed to healthy patients undergoing total hip arthroplasty in order to improve the longevity of the replacement until further studies have confirmed our finding and the mechanisms for this association have been clarified.

Level of Evidence: 

Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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