1279 Does Multimorbidity Influence the Outcomes of Total Hip Replacement for Osteoarthritis?

Abstract Introduction Limited data are available on the influence of multimorbidity on the outcomes of total hip replacement for patients with hip osteoarthritis, including the rate of complications and degree of functional benefit. The aim of this study was to investigate the influence of multimorbidity on the outcomes of total hip replacement in the UK. Method A cohort study was performed, with cohort comprised of all patients over 65 years with a diagnosis of hip osteoarthritis recorded in Clinical Practice Research Datalink and receipt of primary total hip replacement recorded in Hospital Episode Statistics Admitted Patient Care. Severity of multimorbidity burden was measured using four different scores (Charlson Comorbidity Index, Electronic Frailty Index, count of drugs prescribed, count of primary care interactions). The outcomes were (i) the risks of total hip replacement, assessed by serious post-operative complications within 90 days (analysed with logistic regression), and (ii) the benefits of surgery, assessed by post-operative Oxford Hip Score (OHS) and EQ-5D quality of life score (analysed with linear regression). Results 6,682 patients were included. The rate of complications was 3.2%. Patients with severe multimorbidity burden were at 1.5 to 2.5 times increased risk of complications than patients without multimorbidity. There was no clinically meaningful difference in the benefits of surgery between patients with and without multimorbidity, irrespective of the method of scoring multimorbidity. Conclusions Even for patients with severe multimorbidity burden, the potential benefits of total hip replacement for osteoarthritis remain substantial, while the increase in risk is relatively small.

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1263 Does Multimorbidity Influence the Likelihood of Receiving A Total Hip Replacement for Osteoarthritis?

British Journal of Surgery ◽

10.1093/bjs/znab259.1038 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

R Ferguson ◽

D Prieto-Alhambra ◽

G Peat ◽

K Jordan ◽

J Valderas ◽

...

Keyword(s):

Total Hip Replacement ◽

Hip Replacement ◽

Frailty Index ◽

Hip Osteoarthritis ◽

Healthcare Management ◽

Practice Research ◽

Clinical Practice Research Datalink ◽

Total Hip ◽

Kaplan Meier ◽

The Uk

Abstract Introduction Limited data are available on the influence of multimorbidity on the outcomes of total hip replacement for patients with hip osteoarthritis. Thus, patients with multimorbidity and their clinicians across the UK are making decisions on whether or not to proceed with total hip replacement without clear information available on the potential risks and benefits. It is not known how such patients are currently managed. The aim of this study was to investigate the influence of multimorbidity on the likelihood of receiving total hip replacement in patients with hip osteoarthritis in the UK. Method A cohort study was performed, with cohort comprised of all patients over 65 years with a diagnosis of hip osteoarthritis recorded in Clinical Practice Research Datalink. Severity of multimorbidity burden was measured using four different scores (Charlson Comorbidity Index, Electronic Frailty Index, count of drugs prescribed, count of primary care interactions). The outcome was total hip replacement, evaluated using Kaplan-Meier survival and competing-risk analyses. Results 28,025 patients were included. 10,948 patients underwent total hip replacement. Increased multimorbidity burden was associated with decreased likelihood of undergoing surgery, irrespective of the method of scoring multimorbidity. Electronic Frailty Index had the largest difference between categories. Adjusted hazard ratio (‘severe multimorbidity versus ‘fit’) was 0.34 (95% CI 0.22, 0.51). Conclusions Patients with hip osteoarthritis and concurrent multimorbidity were up to two thirds less likely to undergo total hip replacement. Whether this difference in healthcare management is appropriate depends on to what extent multimorbidity influences the outcomes of total hip replacement.

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Association between circulating 25-hydroxyvitamin D concentrations and hip replacement for osteoarthritis: a prospective cohort study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04779-4 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Sultana Monira Hussain ◽

Yuanyuan Wang ◽

Alicia K. Heath ◽

Graham G. Giles ◽

Dallas R. English ◽

...

Keyword(s):

Cohort Study ◽

Total Hip Replacement ◽

Prospective Cohort Study ◽

Hip Replacement ◽

Prospective Cohort ◽

Hip Osteoarthritis ◽

Underlying Mechanism ◽

Dried Blood Spots ◽

Total Hip ◽

Increased Risk

Abstract Background To examine the association between circulating 25(OH)D concentrations and incidence of total hip replacement for osteoarthritis in a prospective cohort study. Methods This study examined a random sample of 2651 participants in the Melbourne Collaborative Cohort Study who had 25(OH)D concentrations measured from dried blood spots collected in 1990-1994. Participants who underwent total hip replacement for osteoarthritis between January 2001 and December 2018 were identified by linking the cohort records to the Australian Orthopaedic Association National Joint Replacement Registry. Cox proportional hazard regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) of total hip replacement for osteoarthritis in relation to 25(OH)D concentrations, adjusted for confounders. Results Eighty-six men and eighty-seven women had a total hip replacement for osteoarthritis. Compared with men in the lowest (1st) quartile of 25(OH)D concentration, the HR for total hip replacement was 2.32 (95% CI 1.05, 5.13) for those in the 2nd quartile, 2.77 (95% CI 1.28, 6.00) for those in the 3rd quartile, and 1.73 (95% CI 0.75, 4.02) for those in the highest quartile of 25(OH)D concentrations (p for trend 0.02). There was little evidence of an association in women. Conclusions Higher circulating 25(OH)D concentrations were associated with an increased risk of total hip replacement for osteoarthritis in men but not in women. Although the underlying mechanism warrants further investigation, our findings highlight the need to determine the optimal levels of circulating 25(OH)D to reduce the risk of hip osteoarthritis.

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Paediatric rotavirus vaccination, coeliac disease and type 1 diabetes in children: a population-based cohort study

BMC Medicine ◽

10.1186/s12916-021-02017-1 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Thomas Inns ◽

Kate M. Fleming ◽

Miren Iturriza-Gomara ◽

Daniel Hungerford

Keyword(s):

Type 1 Diabetes ◽

Cohort Study ◽

Coeliac Disease ◽

Practice Research ◽

Clinical Practice Research Datalink ◽

Rotavirus Vaccine ◽

Rotavirus Vaccination ◽

Increased Risk ◽

The Uk

Abstract Background Rotavirus infection has been proposed as a risk factor for coeliac disease (CD) and type 1 diabetes (T1D). The UK introduced infant rotavirus vaccination in 2013. We have previously shown that rotavirus vaccination can have beneficial off-target effects on syndromes, such as hospitalised seizures. We therefore investigated whether rotavirus vaccination prevents CD and T1D in the UK. Methods A cohort study of children born between 2010 and 2015 was conducted using primary care records from the Clinical Practice Research Datalink. Children were followed up from 6 months to 7 years old, with censoring for outcome, death or leaving the practice. CD was defined as diagnosis of CD or the prescription of gluten-free goods. T1D was defined as a T1D diagnosis. The exposure was rotavirus vaccination, defined as one or more doses. Mixed-effects Cox regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CIs). Models were adjusted for potential confounders and included random intercepts for general practices. Results There were 880,629 children in the cohort (48.8% female). A total of 343,113 (39.0%) participants received rotavirus vaccine; among those born after the introduction of rotavirus vaccination, 93.4% were vaccinated. Study participants contributed 4,388,355 person-years, with median follow-up 5.66 person-years. There were 1657 CD cases, an incidence of 38.0 cases per 100,000 person-years. Compared with unvaccinated children, the adjusted HR for a CD was 1.05 (95% CI 0.86–1.28) for vaccinated children. Females had a 40% higher hazard than males. T1D was recorded for 733 participants, an incidence of 17.1 cases per 100,000 person-years. In adjusted analysis, rotavirus vaccination was not associated with risk of T1D (HR = 0.89, 95% CI 0.68–1.19). Conclusions Rotavirus vaccination has reduced diarrhoeal disease morbidity and mortality substantial since licencing in 2006. Our finding from this large cohort study did not provide evidence that rotavirus vaccination prevents CD or T1D, nor is it associated with increased risk, delivering further evidence of rotavirus vaccine safety.

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Development and validation of prediction models to estimate risk of primary total hip and knee replacements using data from the UK: two prospective open cohorts using the UK Clinical Practice Research Datalink

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2018-213894 ◽

2018 ◽

Vol 78 (1) ◽

pp. 91-99 ◽

Cited By ~ 7

Author(s):

Dahai Yu ◽

Kelvin P Jordan ◽

Kym I E Snell ◽

Richard D Riley ◽

John Bedson ◽

...

Keyword(s):

Clinical Practice ◽

Large Scale ◽

Prediction Models ◽

Cox Proportional Hazards ◽

Practice Research ◽

Clinical Practice Research Datalink ◽

Total Hip ◽

Risk Of Death ◽

Geographical Regions ◽

The Uk

ObjectivesThe ability to efficiently and accurately predict future risk of primary total hip and knee replacement (THR/TKR) in earlier stages of osteoarthritis (OA) has potentially important applications. We aimed to develop and validate two models to estimate an individual’s risk of primary THR and TKR in patients newly presenting to primary care.MethodsWe identified two cohorts of patients aged ≥40 years newly consulting hip pain/OA and knee pain/OA in the Clinical Practice Research Datalink. Candidate predictors were identified by systematic review, novel hypothesis-free ‘Record-Wide Association Study’ with replication, and panel consensus. Cox proportional hazards models accounting for competing risk of death were applied to derive risk algorithms for THR and TKR. Internal–external cross-validation (IECV) was then applied over geographical regions to validate two models.Results45 predictors for THR and 53 for TKR were identified, reviewed and selected by the panel. 301 052 and 416 030 patients newly consulting between 1992 and 2015 were identified in the hip and knee cohorts, respectively (median follow-up 6 years). The resultant model C-statistics is 0.73 (0.72, 0.73) and 0.79 (0.78, 0.79) for THR (with 20 predictors) and TKR model (with 24 predictors), respectively. The IECV C-statistics ranged between 0.70–0.74 (THR model) and 0.76–0.82 (TKR model); the IECV calibration slope ranged between 0.93–1.07 (THR model) and 0.92–1.12 (TKR model).ConclusionsTwo prediction models with good discrimination and calibration that estimate individuals’ risk of THR and TKR have been developed and validated in large-scale, nationally representative data, and are readily automated in electronic patient records.

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Validation of hip osteoarthritis diagnosis recording in the UK Clinical Practice Research Datalink

Pharmacoepidemiology and Drug Safety ◽

10.1002/pds.4673 ◽

2018 ◽

Vol 28 (2) ◽

pp. 187-193 ◽

Cited By ~ 3

Author(s):

Rory J. Ferguson ◽

Daniel Prieto‐Alhambra ◽

Christine Walker ◽

Dahai Yu ◽

Jose M. Valderas ◽

...

Keyword(s):

Clinical Practice ◽

Hip Osteoarthritis ◽

Practice Research ◽

Clinical Practice Research Datalink ◽

The Uk

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Does comorbidity affect the outcome of surgery? Total hip replacement in the UK and Japan

International Journal for Quality in Health Care ◽

10.1093/intqhc/10.2.113 ◽

1998 ◽

Vol 10 (2) ◽

pp. 113-123 ◽

Cited By ~ 30

Author(s):

K. Imamura ◽

N. Black

Keyword(s):

Total Hip Replacement ◽

Hip Replacement ◽

Total Hip ◽

The Uk ◽

Outcome Of Surgery

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Contralateral hip and knee gait biomechanics are unchanged by total hip replacement for unilateral hip osteoarthritis

Gait & Posture ◽

10.1016/j.gaitpost.2011.08.006 ◽

2012 ◽

Vol 35 (1) ◽

pp. 61-65 ◽

Cited By ~ 48

Author(s):

Kharma C. Foucher ◽

Markus A. Wimmer

Keyword(s):

Total Hip Replacement ◽

Hip Replacement ◽

Hip Osteoarthritis ◽

Total Hip ◽

Gait Biomechanics

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Total Hip Replacement Provokes Endothelial Dysfunction

Angiology ◽

10.1177/0003319718774660 ◽

2018 ◽

Vol 69 (10) ◽

pp. 871-877 ◽

Cited By ~ 3

Author(s):

Peter Poredos ◽

Ana Mavric ◽

Lara Leben ◽

Pavel Poredos ◽

Mateja Kaja Jezovnik

Keyword(s):

Endothelial Dysfunction ◽

Endothelial Function ◽

Total Hip Replacement ◽

Postoperative Period ◽

Hip Replacement ◽

Hospital Length Of Stay ◽

Average Hospital ◽

Total Hip ◽

Increased Risk ◽

Cardiovascular Homeostasis

Surgery represents an increased risk of different perioperative complications. Endothelial function (EF) is a key mechanism responsible for cardiovascular homeostasis and is involved in thromboembolic complications. We aimed to follow changes of EF in an early postoperative period in patients undergoing total hip replacement (THR). Endothelial function was assessed noninvasively in 70 consecutive patients who underwent an elective THR under spinal anesthesia. Flow-mediated dilation (FMD) and low flow-mediated constriction capability of the brachial artery, which are indicators of EF were measured before the operation (baseline), 24 hours after the operative procedure, and 5 to 7 days postoperatively. Baseline FMD was 12.3% and decreased a day after surgery to 7.3% ( P < .001). After 5 to 7 days, it gradually increased to 9.2%. However, on average, it was lower than before surgery ( P < .001). The median duration of THR was 85.0 (65.0-100.0) minutes, the average hospital length of stay was 7 days. Total hip replacement is associated with an immediate decrease in FMD which remains significantly decreased 5 to 7 days after the surgery compared with the preoperative value. These results indicate that surgery provokes endothelial dysfunction and deteriorates cardiovascular homeostasis. This effect could be involved in cardiovascular complications in the postoperative period.

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