Use of diuretics and risk of implant failure after primary total hip arthroplasty: A nationwide population-based study
Introduction
Diuretics, including thiazid and loop diuretics, are widely used drugs for treatment of hypertension and congestive heart failure. Thiazid diuretics reduce, whereas loop diuretics increase the renal calcium excretion and thereby alter bone metabolism [1]. Previous randomized controlled trials and observational studies have indicated that treatment with thiazides may exert positive effects on bone with an increased bone mineral density (BMD) and decreased risk of fractures [2], [3], [4], [5]. In contrast, loop diuretics have been associated with an increased bone turnover, decreased BMD and increased risk of fractures [4], [6], [7], [8].
Primary total hip arthroplasty (THA) is a well documented treatment of hip joint arthritis providing pain relief and improved function. Various patient related predictors for implant survival after primary THA surgery have been described, e.g., age, gender, co-morbidity, indication for THA, smoking and alcohol [9], [10], [11]. However, information on potential effects of drugs on the implant survival after primary THA is yet sparse [10]. Knowing that diuretics interfere with calcium homeostasis and thus bone metabolism, we hypothesized that thiazides and loop diuretics may influence the implant survival after primary THA surgery. We therefore conducted a nested case-control study of the association between thiazides and loop diuretic use and the risk of revision after primary THA surgery using population-based nationwide medical databases in Denmark. To our knowledge, this is the first epidemiological study to evaluate the effect of diuretic use on the risk of revision after primary THA.
Section snippets
Materials and methods
In Denmark, the National Health Service provides tax-supported healthcare for all inhabitants, allowing free access to general practitioners and hospitals. In addition, part of the costs of prescribed drugs is covered by the healthcare system.
Results
Cases and controls were well matched on gender, age and year of operation and distribution of 25 covariates was equal between cases and controls, whereas distribution of 12 covariates, including county of residence, NSAID use, cerebrovascular disease, peripheral vascular disease, ulcer disease, liver disease, diabetes I and II, diabetes with organ disability, renal disease, Charlson co-morbidity index, implant fixation technique, and diagnosis for primary THA surgery, differed between cases and
Discussion
We report that thiazid users did not have an overall increased risk of revision, except for an increased risk of revision due to miscellaneous causes including pain, implant failure, anisomelia, ectopic bone formation and technical problems. In contrast, loop diuretic users had an overall greater risk of revision after primary THA compared to non-users. In particular, loop diuretic users had an increased risk of revision due to deep infection and periprosthetic fracture. However, the overall
Acknowledgments
This study was supported by the Danish Rheumatism Association and the Augustinus Foundation. The authors thank Anne Hjelm, secretary of the Danish Hip Arthroplasty Registry.
References (27)
- et al.
Hydrochlorothiazide reduces loss of cortical bone in normal postmenopausal women: a randomized controlled trial
Am. J. Med.
(2000 October 1) - et al.
A new method of classifying prognostic comorbidity in longitudinal studies: development and validation
J. Chronic Dis.
(1987) - et al.
Hydrochlorothiazide inhibits bone resorption in men despite experimentally elevated serum 1,25-dihydroxyvitamin D concentrations
Kidney. Int.
(1985 December) - et al.
Current use of thiazide diuretics and prevention of femur fractures
J. Clin. Epidemiol.
(1996 January) - et al.
A summary of the effects of antihypertensive medications on measured blood pressure
Am. J. Hypertens.
(2005 July) Diuretics
Kidney Int.
(1991 February)- et al.
The effect of treatment with a thiazide diuretic for 4 years on bone density in normal postmenopausal women
Osteoporos. Int.
(2007 April) - et al.
Reduced fracture risk in users of thiazide diuretics
Calcif. Tissue Int.
(2005 March) - et al.
Thiazide diuretics and the risk for hip fracture
Ann. Intern. Med.
(2003 September 16) - et al.
Loop diuretic use and increased rates of hip bone loss in older men: the Osteoporotic Fractures in Men Study
Arch. Intern. Med.
(2008 April 14)
Fracture risk in patients treated with loop diuretics
J. Intern. Med.
Loop diuretics increase bone turnover and decrease BMD in osteopenic postmenopausal women: results from a randomized controlled study with bumetanide
J. Bone Miner. Res.
Patient-related predictors of implant failure after primary total hip replacement in the initial, short- and long-terms: a nationwide Danish follow-up study including 36 984 patients
J. Bone Joint Surg. Br.
Cited by (11)
Postoperative use of bisphosphonates and risk of revision after primary total hip arthroplasty: A nationwide population-based study
2010, BoneCitation Excerpt :Finally, as in all observational studies, we cannot entirely exclude the possibility of residual and unaccounted confounding (e.g., severity of osteoporosis, smoking, physical activity level, body weight and surgeon experience). The 10-year revision rate of osteoporotic patients was comparable to previously reported 10-year revision rates of all patients from the Danish Hip Arthroplasty Register (8.9% (CI 95%: 8.4–9.4)) [16]. To our knowledge THA revision rates in patients with osteoporosis have not previously been reported.
The Risk of revision after primary total hip arthroplasty among statin users: A nationwide population-based nested case-control study
2010, Journal of Bone and Joint SurgeryCitation Excerpt :An alternative way to have an impression of the possible extent of unaccounted-for confounding could be to study the association between the use of other classes of drugs for cardiovascular prevention and the risk of revision total hip arthroplasty. We recently reported on the association between the use of diuretics and the risk of revision in the same study population22. Diuretics are used in Denmark as a first-line choice for the treatment of hypertension and prevention of hypertension-related cardiovascular complications including myocardial infarction and stroke.
Current methods of preventing aseptic loosening and improving osseointegration of titanium implants in cementless total hip arthroplasty: a review
2018, Journal of International Medical Research