Key result
Achieving target LDL-C <3 mmol/L linked to ~26% lower 5-year joint revision risk.
Why the study?
Hyperlipidaemia is common and often untreated in knee and hip replacement patients, and while elevated LDL-C is linked to postoperative pain and prosthetic joint infections, the impact of LDL-C lowering on revision surgery remained unclear.
Does achieving a target LDL-C level <3 mmol/L within a 1-year grace period reduce the 5-year risk of revision surgery in patients with hyperlipidaemia undergoing knee and hip replacement?
Cohort (n=28,756)
Yes
Does achieving a target LDL-C level <3 mmol/L within a 1-year grace period reduce the 5-year risk of revision surgery in patients with hyperlipidaemia undergoing knee and hip replacement?
Answers are grounded in this paper and cite their sources.
Achieving an LDL-C target <3 mmol/L within 1 year of initiating lipid-lowering therapy is associated with a significantly lower 5-year risk of revision surgery in patients with hyperlipidaemia undergoing joint replacement, particularly knee replacement.
Objective Hyperlipidaemia is common in knee and hip replacement patients, with nearly half untreated. Elevated low-density lipoprotein cholesterol (LDL-C) has been associated with postoperative pain and prosthetic joint infections; however, the impact of LDL-C lowering on revision surgery remains unclear. We aimed to examine the association between pragmatic LDL-C management strategies, operationalized according to LDL-C target attainment during the 1-year grace period, and the risk of revision among patients with hyperlipidaemia undergoing knee and hip replacement. Methods Using The Health Improvement Network database, we identified knee and hip replacement patients with hyperlipidaemia aged 40 years or older initiating LDL-C-lowering medications. We emulated a hypothetical target trial to compare the 5-year revision risk between pragmatic LDL-C management strategies, with adherence to the goal-based strategy operationalized as having an LDL-C level <3 mmol/L during the 1-year grace period. Results Among 28,756 qualified participants, the 5-year revision risk was lower in those achieving the target LDL-C level (2.35%) compared to those not achieving it (2.76%), with a risk difference of −0.41% (95%CI: −0.72% to −0.09%), and a hazard ratio (HR) of 0.74 (95%CI: 0.61 to 0.90). For knee replacement revision, the 5-year risk difference was −0.47% (95%CI: −0.91% to −0.09%), with an HR of 0.69 (95%CI: 0.51 to 0.92). For hip replacement revision, the 5-year risk difference was −0.28% (95%CI: −0.80% to 0.20%), with an HR of 0.80 (95%CI: 0.63 to 1.01). Conclusion Adherence to a goal-based LDL-C management strategy, operationalized as having an LDL-C level <3 mmol/L during the 1-year grace period, was associated with a lower risk of revision surgery among patients with hyperlipidaemia undergoing joint replacement, especially after knee replacement. The translational potential of this article This study highlights postoperative lipid management as a potentially modifiable component of joint replacement care. If confirmed in future prospective studies, strategies to achieve guideline-recommended LDL-C targets may be considered as part of routine postoperative management to potentially improve long-term outcomes following joint replacement.
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Li et al. (2026) conducted a cohort in Hyperlipidaemia in knee and hip replacement patients (n=28,756). Goal-based LDL-C management strategy (achieving LDL-C <3 mmol/L within 1 year) vs. Not achieving LDL-C <3 mmol/L during the 1-year grace period was evaluated on 5-year revision surgery following knee or hip replacement (HR 0.74, 95% CI 0.61-0.90). Achieving an LDL-C target <3 mmol/L within 1 year was associated with a lower 5-year joint replacement revision risk compared to non-attainment (2.35% vs 2.76%; HR 0.74, 95% CI 0.61-0.90).
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