Background:

Multiple sclerosis (MS) is a neuroinflammatory disease with debilitating manifestations that may predispose patients to hip fracture and osteoarthritis, and may affect recovery from total hip arthroplasty (THA). With increased longevity of MS patients and growth in demand for arthroplasty in this population, it is important to understand outcomes of THA in patients with MS.

Aim:

We sought to compare outcomes of THA among persons with MS and without MS.

Methods:

International Classification of Diseases, Ninth Revision Procedure Coding System (ICD-9-PCS) codes for hip arthroplasty (815.1) were used to identify all patients in the New York Statewide Planning and Research Cooperative System (SPARCS) database who underwent THA between 2000 and 2014. Patients with MS, the primary exposure, were identified using ICD-9-Clinical Modification (CM) code 340. The study outcomes of length of stay (days), discharge disposition, index admission mortality, 90-day readmission, 1-year revision arthroplasty, and 1-year all-cause mortality were evaluated using multivariable regression analyses inclusive of basic demographics, admission source, disposition, payer, comorbidity, and socioeconomic status (SES).

Results:

Compared to patients without MS, those with MS had marginally longer lengths of stay (mean ratio [MR] 1.05; 95% confidence interval [CI], 1.01–1.10; p = 0.0142), higher risk for institutional discharge disposition (odds ratio [OR] 2.03; 95% CI, 1.54–2.70; p < 0.0001) and higher risk of readmission for revision hip arthroplasty (OR 2.60; 95% CI, 1.07–6.35; p = 0.035). However, MS patients had similar risk for 90-day readmission and one-year all-cause mortality as compared with non-MS patients.

Conclusions:

Although patients with MS who underwent THA had a 90-day complication risk that was similar to those without MS, the risk for requiring revision surgery was more than 2-fold higher. Additional studies are needed to understand the reasons for revision surgery and for developing strategies to mitigate the risk of complications.

中文翻译：

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多发性硬化和非多发性硬化患者全髋关节置换术的结果：一项回顾性队列研究

背景：

多发性硬化症 (MS) 是一种神经炎症性疾病，具有使人衰弱的表现，可能使患者易患髋部骨折和骨关节炎，并可能影响全髋关节置换术 (THA) 的恢复。随着 MS 患者寿命的延长和该人群对关节置换术需求的增长，了解 THA 在 MS 患者中的结果非常重要。

目标：

我们试图比较 MS 患者和非 MS 患者的 THA 结果。

方法：

国际疾病分类，髋关节置换术的第九次修订程序编码系统 (ICD-9-PCS) 代码 (815.1) 用于识别纽约州规划和研究合作系统 (SPARCS) 数据库中在 2000 年至 2000 年间接受 THA 的所有患者2014. 使用 ICD-9-Clinical Modification (CM) 代码 340 确定主要暴露的 MS 患者。研究结果包括住院时间（天）、出院处置、指数入院死亡率、90 天再入院、1-使用包括基本人口统计、入院来源、处置、付款人、合并症和社会经济地位 (SES) 在内的多变量回归分析评估了一年翻修关节成形术和 1 年全因死亡率。

结果：

与没有 MS 的患者相比，患有 MS 的患者的住院时间稍长（平均比率 [MR] 1.05；95% 置信区间 [CI]，1.01-1.10；p  = 0.0142），机构出院处置的风险更高（优势比 [ OR] 2.03；95% CI，1.54–2.70；p  < 0.0001）和更高的翻修髋关节置换术再入院风险（OR 2.60；95% CI，1.07–6.35；p  = 0.035）。然而，与非 MS 患者相比，MS 患者 90 天再入院和一年全因死亡率的风险相似。

结论：

尽管接受 THA 的 MS 患者的 90 天并发症风险与没有 MS 的患者相似，但需要翻修手术的风险高出 2 倍以上。需要更多的研究来了解翻修手术的原因并制定降低并发症风险的策略。