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Cook MJ, Sorial AK, Lunt M, Board TN, O'Neill TW. Effect of Timing and Duration of Statin Exposure on Risk of Hip or Knee Revision Arthroplasty: A Population-based Cohort Study. J Rheumatol 2019; 47:441-448. [PMID: 30877207 DOI: 10.3899/jrheum.180574] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To determine whether the timing and duration of statin exposure following total hip/knee arthroplasty (THA/TKA) influence the risk of revision arthroplasty. METHODS Subjects from the Clinical Practice Research Datalink, a large population-based clinical database, who had THA/TKA from 1988 to 2016, were included. Propensity score adjusted Cox regression models were used to determine the association between statin exposure and the risk of revision THA/TKA, (1) at any time, and (2) if first exposed 0-1, 1-5, or > 5 years following THA/TKA. We also investigated the effect of duration of statin exposure (< 1, 1-2, 2-3, 3-4, 4-5, > 5 yrs). RESULTS The study included 151,305 participants. There were 65,032 (43%) exposed to statins during followup and 3500 (2.3%) had revision arthroplasty. In a propensity score adjusted model, exposure to statins was associated with a reduced risk of revision arthroplasty (HR 0.82, 95% CI 0.75-0.90). Participants first exposed within 1 year and between 1 and 5 years following THA/TKA (vs unexposed) had a reduced risk of revision arthroplasty (HR 0.82, 95% CI 0.74-0.91 and HR 0.76, 95% CI 0.65-0.90, respectively). In relation to duration of statin therapy, participants exposed for more than 5 years in total (vs < 1 yr) had a reduced risk of revision (HR 0.74, 95% CI 0.62-0.88). CONCLUSION Statin therapy initiated up to 5 years following THA/TKA may reduce the risk of revision arthroplasty.
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Affiliation(s)
- Michael J Cook
- From the Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester; Institute of Genetic Medicine, Newcastle University; The Centre for Hip Surgery, Wrightington Hospital, Wrightington Wigan and Leigh National Health Service (NHS) Foundation Trust, Wigan; UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester; Department of Rheumatology, Salford Royal NHS Foundation Trust, Salford, UK.,M.J. Cook, MSc, Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester; A.K. Sorial, MRCS, Institute of Genetic Medicine, Newcastle University; M. Lunt, PhD, Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre; T.N. Board, MD, The Centre for Hip Surgery, Wrightington Hospital, Wrightington Wigan and Leigh NHS Foundation Trust; T.W. O'Neill, MD, Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, and Department of Rheumatology, Salford Royal NHS Foundation Trust
| | - Antony K Sorial
- From the Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester; Institute of Genetic Medicine, Newcastle University; The Centre for Hip Surgery, Wrightington Hospital, Wrightington Wigan and Leigh National Health Service (NHS) Foundation Trust, Wigan; UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester; Department of Rheumatology, Salford Royal NHS Foundation Trust, Salford, UK.,M.J. Cook, MSc, Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester; A.K. Sorial, MRCS, Institute of Genetic Medicine, Newcastle University; M. Lunt, PhD, Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre; T.N. Board, MD, The Centre for Hip Surgery, Wrightington Hospital, Wrightington Wigan and Leigh NHS Foundation Trust; T.W. O'Neill, MD, Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, and Department of Rheumatology, Salford Royal NHS Foundation Trust
| | - Mark Lunt
- From the Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester; Institute of Genetic Medicine, Newcastle University; The Centre for Hip Surgery, Wrightington Hospital, Wrightington Wigan and Leigh National Health Service (NHS) Foundation Trust, Wigan; UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester; Department of Rheumatology, Salford Royal NHS Foundation Trust, Salford, UK.,M.J. Cook, MSc, Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester; A.K. Sorial, MRCS, Institute of Genetic Medicine, Newcastle University; M. Lunt, PhD, Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre; T.N. Board, MD, The Centre for Hip Surgery, Wrightington Hospital, Wrightington Wigan and Leigh NHS Foundation Trust; T.W. O'Neill, MD, Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, and Department of Rheumatology, Salford Royal NHS Foundation Trust
| | - Tim N Board
- From the Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester; Institute of Genetic Medicine, Newcastle University; The Centre for Hip Surgery, Wrightington Hospital, Wrightington Wigan and Leigh National Health Service (NHS) Foundation Trust, Wigan; UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester; Department of Rheumatology, Salford Royal NHS Foundation Trust, Salford, UK.,M.J. Cook, MSc, Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester; A.K. Sorial, MRCS, Institute of Genetic Medicine, Newcastle University; M. Lunt, PhD, Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre; T.N. Board, MD, The Centre for Hip Surgery, Wrightington Hospital, Wrightington Wigan and Leigh NHS Foundation Trust; T.W. O'Neill, MD, Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, and Department of Rheumatology, Salford Royal NHS Foundation Trust
| | - Terence W O'Neill
- From the Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester; Institute of Genetic Medicine, Newcastle University; The Centre for Hip Surgery, Wrightington Hospital, Wrightington Wigan and Leigh National Health Service (NHS) Foundation Trust, Wigan; UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester; Department of Rheumatology, Salford Royal NHS Foundation Trust, Salford, UK. .,M.J. Cook, MSc, Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester; A.K. Sorial, MRCS, Institute of Genetic Medicine, Newcastle University; M. Lunt, PhD, Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre; T.N. Board, MD, The Centre for Hip Surgery, Wrightington Hospital, Wrightington Wigan and Leigh NHS Foundation Trust; T.W. O'Neill, MD, Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, and Department of Rheumatology, Salford Royal NHS Foundation Trust.
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