gms | German Medical Science

German Congress of Orthopedic and Trauma Surgery (DKOU 2017)

24.10. - 27.10.2017, Berlin

Link between non-traumatic osteonecrosis of femoral head and major adverse cardiovascular and cerebrovascular events: a nationwide population-based cohort study

Meeting Abstract

Search Medline for

  • presenting/speaker Pei-Hsun Sung - Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
  • Yao-Hsu Yang - Chang Gung Memorial Hospital, Chiayi, Chiayi, Taiwan
  • Hon-Kan Yip - Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
  • Mel S. Lee - Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2017). Berlin, 24.-27.10.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocIN14-183

doi: 10.3205/17dkou036, urn:nbn:de:0183-17dkou0368

Published: October 23, 2017

© 2017 Sung et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objectives: Endothelial dysfunction has been established to be essential for osteonecrosis of femoral head (ONFH) and major adverse cardiovascular and cerebrovascular events (MACCE) [defined as major cardiovascular disease (CVD)/cerebrovascular accident (CVA)]. However, the incidence and risk of MACCE in ONFH patients are currently unclear, suggesting a clinical important issue to be addressed.

Methods: A population-based cohort with a 14-year dataset period (1997-2010) from Taiwan National Health Insurance Research Database (NHIRD) was utilized for the retrospective study. Totally, 1,562 non-traumatic ONFH patients were identified from 1,000,000 general populations after excluding initially concomitant diagnoses of major CVD and CVA. The comparison group (n=15,620) without ONFH was set-up in a 1:10 ratio by matching study cohort with age, gender, income and urbanization. We compared the distribution of demographic factors and the rate of comorbidities between the study cohort and matched control cohort with the independent t test and Chi-square test. The Kaplan-Meier method was utilized to estimate cumulative incidences and Log-Rank test was performed to examine differences between the two groups. Furthermore, Cox proportional hazard regression models were used to compute the hazard ratios (HRs) after adjusting for age, gender, surgery, and comorbidities.

Results and Conclusion: At the end of follow-up period, the ONFH patients had significantly higher frequency of MACCE than non-ONFH counterparts (18.69% vs. 13.56%, p<0.0001). Further analysis demonstrated that cumulative incidence of MACCE was significantly higher in the ONFH than non-ONFH group (p< 0.001). After adjustment with multivariate analysis, ONFH patients had 1.34- and 1.27-fold risk for occurrence of major CVD and CVA as compared to the normal population (95% CI: 1.11-1.61 and 1.09-1.47), respectively. Furthermore, aside from age >65 years and traditional atherosclerotic risk factors, ONFH was independently predictive of major CVD and CVA (p<0.04). On the contrary, history of lower extremity surgery not only didn't increase the risk of MACCE (adjusted HR 0.82, 95% CI 0.57-1.18) but also protected against CVA (adjusted HR 0.64, 95% CI 0.45-0.92). In conclusion, the patients with ONFH have substantially higher risk of MACCE as compared with normal population.