Asymptomatic osteolysis as a risk factor for cardiovascular disease after total hip arthroplasty: A retrospective cohort study

BACKGROUND AND PURPOSE: A clinical problem in total hip arthroplasty (THA) is periprosthetic osteolysis/aseptic loosening. There is a possible association between periprosthetic osteolysis and higher risk of cardiovascular disease (CVD). The aim of this study was to investigate whether THA patients with asymptomatic periacetabular osteolysis, have an increased long-term risk of CVD compared to THA patients without osteolysis, assess time to the event, and compare possible cardiovascular risk markers between the two groups. PATIENTS AND METHODS: We conducted a retrospective cohort study of 139 patients treated with uncemented THA between 1992 and 2007. All patients were assessed by computed tomography of the affected hip to sort patients in one group with osteolysis and one without. The statistical analysis was based on descriptive statistics. The Kaplan-Meier method was used to estimate time to event and Cox regression models were fitted to calculate crude and adjusted hazard ratios (HR) with 95% confidence intervals (95% CI). RESULTS: There were 33 patients with periacetabular osteolysis and 106 patients without. Mean follow-up time was 16.6 years (range, 12-30). 16 patients (11%) were diagnosed with CVD after a mean (SD) of 14 (6) years, with a higher relative incidence 8/33 (24%) vs 8/106 (8%) of CVD among patients with periacetabular osteolysis. The hazard ratio was 1.6, 95% confidence interval (0.4-5.8). There were no differences in presence of cardiovascular risk markers or ECG abnormalities. INTERPRETATION: We found no association between periacetabular osteolysis and possible risk markers for CVD. There was a trend towards higher incidence of CVD among patients with periacetabular osteolysis. Based on the results from our relatively small cohort it cannot be excluded that low-grade peri-implant inflammation may increase long term risk of CVD following THA.