Article
Osteoarthritis-patterns, cardio-metabolic risk factors and risk of all-cause mortality: 20 years follow-up in patients after hip or knee replacement
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Authors
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Rolf Brenner
- Universitätsklinikum Ulm, Klinik für Orthopädie, Sektion Biochemie der Gelenks- und Bindegewebserkrankungen, Ulm, Germany
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Giesela Büchele
- Institut für Epidemiologie und Medizinische Biometrie, Universität Ulm, Ulm, Germany
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Klaus-Peter Günther
- Universitätsklinikum Carl Gustav Carus Dresden, Dresden, Germany
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Hermann Brenner
- Klinische Epidemiologie und Alternsforschung, Deutsches Krebsforschungsinstitut, Heidelberg, Germany
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Wolfhart Puhl
- Orthopädische Spezialklinik Oberstdorf, Oberstdorf, Germany
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Til Stürmer
- Department of Epidemiology, School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, United States
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Dietrich Rothenbacher
- Institut für Epidemiologie und Medizinische Biometrie, Universität Ulm, Ulm, Germany
| Published: | November 6, 2018 |
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Outline
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Objectives: To investigate 20-year all-cause-mortality in patients with hip or knee arthroplasty from a large and previously well characterized German Osteoarthritis Study-cohort, in comparison to general population. Furthermore, to enlighten the triangle between the baseline life-style and cardio-metabolic risk factors, phenotypic patterns of osteoarthritis (laterality, generalization, cause) and all-cause mortality.
Methods: In the baseline investigation there were N=809 patients with knee (N=389) or hip (N=420) OA included. Mortality was assessed during follow-ups and after 18-20 years. Standardized mortality ratios were determined. Adjusted odds ratios were calculated to describe associations of covariates with OA-patterns. Adjusted hazard ratios quantified the associations of OA-patterns and covariates with all-cause mortality.
Results and conclusion: At the end of 20 years' follow-up N=407 (50.3%) patients were deceased, N=13(1.6%) were lost to follow-up and N=389 (48.1%) were alive. After five years, cohort-mortality was reduced, however 18-20 years later slightly increased, but there was no increased mortality in the whole patient population after 20 years compared to the general population. After mutual adjustment, OA-patterns were associated with age, cholesterol, and overweight/obesity. In comparison to secondary OA an increased mortality was observed for patients with idiopathic OA (p<0.017) in combination with age, smoking, overweight/obesity, diabetes, hypertension, cardiac insufficiency, uric acid, and lower cholesterol. Significantly increased mortality in idiopathic compared to secondary OA suggests a subtype-specific involvement of systemic co-factors in the determination of all-cause mortality. Because cardio-metabolic risk factors were associated with an increased risk of bilateral OA and lower long-term survival, those risk factors should be consequently targeted in OA-patients.
