Objectives

Osteoarthritis (OA) is a common degenerative joint disease, and total knee replacement (TKR) is a successful surgical intervention for knee OA treatment. However, the risks of mortality and major cardiovascular events (MACEs) in patients receiving TKR remain unclear. This study investigated the risks of mortality and MACEs in knee OA patients who received TKR.

Methods

For this population-based cohort study, the Longitudinal Health Insurance Database 2000 was used. Two million individuals with knee OA defined by ICD-9-CM codes who received physical therapy between 1999 and 2017 were selected. For propensity score matching (PSM), we considered the year of knee OA diagnosis, demographics, comorbidities, co-medications, and knee OA–related hyaluronic acid or physical therapy at baseline. After PSM, regression analyses were performed to assess the association of mortality or MACEs with TKR and non-TKR individuals.

Results

We identified patients (n = 189,708) with a new diagnosis of knee OA between 2000 and 2017. In total, 10,314 propensity-score-paired TKR and non-TKR individuals were selected. The PSM cohort algorithm revealed that the risk of mortality or MACEs was lower in the TKR group (adjusted hazard ratio: 0.791; 95% confidence interval: 0.755–0.830) than in the non-TKR group.

Conclusions

Patients with knee OA who received TKR had decreased risks of mortality and MACEs than those who did not receive TKR. Moreover, the TKR group received a reduced dosage of nonsteroidal anti-inflammatory drugs at the 1-year follow-up.

中文翻译：

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骨关节炎患者全膝关节置换降低主要不良心脏事件风险：一项 18 年回顾性队列研究

目标

骨关节炎（OA）是一种常见的退行性关节疾病，全膝关节置换术（TKR）是一种成功的膝关节OA治疗手术干预。然而，接受 TKR 的患者的死亡率和主要心血管事件 (MACE) 的风险仍不清楚。本研究调查了接受 TKR 的膝关节 OA 患者的死亡率和 MACE 风险。

方法

对于这项基于人群的队列研究，使用了 2000 年纵向健康保险数据库。选择了在 1999 年至 2017 年间接受物理治疗的 200 万由 ICD-9-CM 代码定义的膝关节 OA 患者。对于倾向评分匹配 (PSM)，我们在基线时考虑了膝关节 OA 诊断的年份、人口统计学、合并症、联合用药和膝关节 OA 相关的透明质酸或物理治疗。在 PSM 之后，进行回归分析以评估死亡率或 MACE 与 TKR 和非 TKR 个体的关联。

结果

我们确定了 2000 年至 2017 年间新诊断为膝关节 OA 的患者 ( n  = 189,708)。总共选择了 10,314 名倾向评分配对的 TKR 和非 TKR 个体。PSM 队列算法显示，TKR 组的死亡率或 MACE 风险（调整后的风险比：0.791；95% 置信区间：0.755-0.830）低于非 TKR 组。

结论

接受 TKR 的膝关节 OA 患者的死亡率和 MACE 风险低于未接受 TKR 的患者。此外，TKR 组在 1 年的随访中减少了非甾体抗炎药的剂量。