Risk of Venous Thromboembolic Events in Patients with Osteonecrosis of the Femoral Head Undergoing Primary Hip Arthroplasty

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.

HIV-Positive Patients Are at Increased Risk of Venous Thromboembolism After Total Joint Replacement

“…Although historically, outcomes in patients undergoing TJR for osteonecrosis are worse than those with osteoarthritis, none of patients in the HIV group with osteonecrosis as the presenting diagnosis developed VTE 37 (Table 4). Furthermore, a large study by Sung et al 38 demonstrated similar VTE rates after THA for patients with and without osteonecrosis of the femoral head, thus this likely is less likely to explain the difference in VTE rate between the two groups.…”

Young, healthy males and females present cardiometabolic protection against the detrimental effects of a 7-day high-fat high-calorie diet

“…It should be noted that males had a higher ALT concentration resulting in a lower AST/ALT ratio at baseline and after the HFHC diet. Elevated ALT is associated with fatty liver and non-alcoholic fatty liver disease but does not define a specific disease [ 54 ]. The reported upper limit of normal of ALT varies greatly between laboratories and sexes (35–79 U.L −1 for males and 31–55 U.L −1 for females) [ 55 ], and although it is established that healthy males have higher ALT concentrations compared to healthy females [ 56 ], the mechanisms underpinning this differences are unknown [ 57 ].…”

“…The reported upper limit of normal of ALT varies greatly between laboratories and sexes (35–79 U.L −1 for males and 31–55 U.L −1 for females) [ 55 ], and although it is established that healthy males have higher ALT concentrations compared to healthy females [ 56 ], the mechanisms underpinning this differences are unknown [ 57 ]. The two-fold greater ALT concentration in males compared to females in the present study reflects the available epidemiological data [ 54 – 57 ] but is not elevated to an extent which might suggest signs of NAFLD. We anticipated to see increases in the plasma concentration of both triacylglycerol and fatty acids as markers of lipid overload; however, none of these plasma lipid concentrations increased following the HFHC diet in either sex (Table 4 ).…”