Abstract
Previous data have shown patients with osteonecrosis of the femoral head (ONFH) have increased lifelong risk of unprovoked venous thromboembolic events (VTE) as compared with the general population, according to sharing common pathological mechanism of endothelial dysfunction. However, whether the risk of VTE increases in those ONFH patients undergoing major hip replacement surgery remains unclear. This is a retrospective nationwide Asian population-based study. From 1997 to 2013, a total of 12,232 ONFH patients receiving partial or total hip replacement for the first time and revision surgeries were retrospectively selected from Taiwan Health Insurance surgical files. By 1:1 matching on age, sex, surgical types, and socioeconomic status, 12,232 subjects without ONFH undergoing similar hip surgery were selected as non-ONFH group. The incidence and risk of post-surgery VTE, including deep venous thrombosis (DVT) and pulmonary embolism (PE), were compared between the ONFH and non-ONFH groups. Results showed that 53.8% of ONFH patients were male and the median age was 61.9 years old. During the mean follow-up period of 6.4 years, the incidences of VTE (1.4% vs. 1.2%), DVT (1.1% vs. 0.9%), and PE (0.4% vs. 0.4%) were slightly but insignificantly higher in the ONFH than in the non-ONFH group undergoing the same types of major hip replacement surgery (all p-values > 0.250). Concordantly, we found no evidence that the risk of VTE was increased in the ONFH patients as compared with the non-ONFH counterparts (adjusted HR 1.14; 95% CI 0.91–1.42; p = 0.262). There were also no increased risks for DVT and PE in the ONFH subgroups stratified by comorbidities, drug exposure to pain-killer or steroid, and follow-up duration after surgery, either. In conclusion, hip arthroplasty in Asian patients with ONFH is associated with similar rates of VTE as compared to patients with non-ONFH diagnoses.
Highlights
Osteonecrosis of the femoral head (ONFH) commonly affects middle-aged adults and there are more than 10,000 incidental ONFH per year reported in the United States [1]
Even though we excluded those with repeated lower limb surgery (LLS) in the beginning, there were still 1% of cases undergoing revision operation, suggesting their first primary THR or PHR was performed before 18 years ago
The frequency of drug exposure to non-steroidal anti-inflammatory drug (NSAID) or steroid for ≥1 month was significantly higher in the ONFH than non-ONFH group
Summary
Osteonecrosis of the femoral head (ONFH) commonly affects middle-aged adults and there are more than 10,000 incidental ONFH per year reported in the United States [1]. Anticoagulant or intermittent pneumatic compression for thromboprophylaxis in patients receiving surgery to reduce perioperative thromboembolism is recommended by clinical guidelines [19]. Compared to those with other reasons for lower limb surgery (LLS), ONFH population develops symptoms in young age, possesses diathesis of endothelial dysfunction, and may undergo several times of hip surgery in their lifetime. The risk of postoperative VTE in patients with ONFH undergoing hip replacement surgery remains regrettably unanswered.
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