Introduction

The use of proton pump inhibitors (PPIs) has been associated with a higher risk of osteoporotic fractures and non-unions rates. However, the relation between the use of PPIs and the development of aseptic loosening in arthroplasty procedures has not been studied. The objective of this study is to analyze the relation between the use of PPIs, and the risk of early aseptic loosening in total knee arthroplasty (TKA) and total hip arthroplasty (THA).

Materials and methods

A nested case-control study was conducted on patients who were subjected THA or TKA in our center between 2010 and 2014. Cases were patients subjected to revision surgery due to early aseptic loosening during the study period. Cases were matched with controls who did not require any type of revision surgery by type of joint replacement (THA/TKA), gender, age (+/− 2 years), and follow-up time (±6 months). Odds Ratios were adjusted to potential confounders.

Results

The crude and adjusted ORs (95% CI) of undergoing revision surgery for aseptic loosening following primary total knee arthroplasty or total hip arthroplasty, were 6.25 (2.04–19.23) and 6.10 (1.71–21.73), respectively, for any use PPIs compared with non-users. Crude and adjusted ORs, were 11.6 (2.93–45.88) and 17.1 (2.41–121.66), respectively, for patients with a Proportion of Days Covered (PDC) for PPIs <.5 (Table 2). In addition, the crude and adjusted ORs of undergoing revision surgery, were 5.05 (1.59–16.02) and 5.01 (1.36–18.44), respectively, for patients with a PDC for PPIs ≥.5.

Discussion

These results suggest that PPIs should be used with caution in patients with TKA and THA, and that the use of these drugs should not be prolonged unless there was a justifiable indication.

Conclusions

The use of PPIs and was associated with a higher risk of early aseptic loosening in patients subjected to THA and TKA.

中文翻译：

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质子泵抑制剂和髋膝关节置换术中早期无菌性松动的风险

介绍

质子泵抑制剂 (PPI) 的使用与更高的骨质疏松性骨折风险和不愈合率相关。然而，尚未研究 PPI 的使用与关节置换术中无菌性松动的发展之间的关系。本研究的目的是分析 PPI 的使用与全膝关节置换术 (TKA) 和全髋关节置换术 (THA) 中早期无菌性松动风险之间的关系。

材料和方法

对 2010 年至 2014 年在我们中心接受 THA 或 TKA 的患者进行了巢式病例对照研究。病例是在研究期间由于早期无菌性松动而接受翻修手术的患者。根据关节置换类型（THA/TKA）、性别、年龄（+/- 2 年）和随访时间（±6 个月），将病例与不需要任何类型翻修手术的对照组进行匹配。优势比根据潜在的混杂因素进行了调整。

结果

与任何使用 PPI 相比，初次全膝关节置换术或全髋关节置换术后因无菌性松动而接受翻修手术的粗略和调整后 ORs（95% CI）分别为 6.25（2.04-19.23）和 6.10（1.71-21.73）。非用户。对于 PPI <.5 的覆盖天数比例 (PDC) 的患者，粗略和调整后的 OR 分别为 11.6 (2.93–45.88) 和 17.1 (2.41–121.66)（表 2）。此外，对于 PPI ≥.5 的 PDC 患者，接受翻修手术的粗略和调整后的 OR 分别为 5.05 (1.59-16.02) 和 5.01 (1.36-18.44)。

讨论

这些结果表明，在 TKA 和 THA 患者中应谨慎使用 PPI，除非有合理的指征，否则不应延长这些药物的使用时间。

结论

PPI 的使用与接受 THA 和 TKA 的患者早期无菌性松动的风险较高相关。