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Increased risk of chronic osteomyelitis after hip replacement: a retrospective population-based cohort study in an Asian population

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Abstract

The correlation between hip replacement (Hip-Repl) and chronic osteomyelitis (COM) has not been studied in Asian populations. Thus, we assessed Hip-Repl-related risk of developing COM via a population-based, nationwide, retrospective cohort study. The Hip-Repl cohort was obtained from Taiwan’s Longitudinal Health Insurance Database 2000, and included patients who underwent Hip-Repl between 2000 and 2010; the control cohort was also selected from this database. Patients with a history of COM were excluded in both cohorts. We used univariate and multivariate Cox proportional hazards regression models to calculate the adjusted hazard ratios (aHRs) by age, sex, and comorbidities for developing COM. A total of 5349 patients who received a Hip-Repl and 10,372 matched controls were enrolled. In the Hip-Repl group, the risk for COM was 4.18-fold [95 % confidence interval (CI) = 2.24–7.80] higher than that in the control group after adjustment. For patients aged ≤65 years, the risk was 10.0-fold higher (95 % CI = 2.89–34.6). Furthermore, the risk was higher in the Hip-Repl cohort than in the non-Hip-Repl cohort, for both patients without comorbidity (aHR = 16.5, 95 % CI = 2.07–132.3) and those with comorbidity (aHR = 3.49, 95 % CI = 1.78–6.83). The impact of Hip-Repl on the risk for COM was greater among patients not using immunosuppressive drugs, and occurred during the first postoperative year. Patients who received Hip-Repl have an increased risk of developing COM. This risk was higher among males and patients aged 65 years or younger, and during the first postoperative year.

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Abbreviations

Hip-Repl:

Hip replacement

OM:

Osteomyelitis

COM:

Chronic osteomyelitis

HR:

Hazard ratio

CI:

Confidence interval

ICD-9-CM:

International Classification of Diseases, Ninth Revision, Clinical Modification

NHI:

National Health Insurance

NHIRD:

National Health Insurance Research Database

NHRI:

National Health Research Institutes

LHIRD:

Longitudinal Health Insurance Research Database

References

  1. Schwartsmann CR, Spinelli LdeF, Boschin LC et al (2015) Correlation between patient age at total hip replacement surgery and life expectancy. Acta Ortop Bras 23:323–325

    PubMed  Google Scholar 

  2. Kurtz S, Mowat F, Ong K et al (2005) Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg Am 87:1487–1497

    PubMed  Google Scholar 

  3. National Joint Registry (NJR) for England, Wales, Northern Ireland and the Isle of Man. StatsOnline. NJR, Hemel Hempstead. Home page at: http://www.njrcentre.org.uk/njrcentre/Home/tabid/36/Default.aspx. Last accessed October 2011

  4. Organisation for Economic Co-operation and Development (OECD) (2011) Health at a glance 2011: OECD indicators. OECD, Paris. Available online at: http://www.oecd-ilibrary.org/social-issues-migration-health/health-at-a-glance-2011_health_glance-2011-en. Last accessed December 2014

  5. Lai YS, Wei HW, Cheng CK (2008) Incidence of hip replacement among national health insurance enrollees in Taiwan. J Orthop Surg Res 3:42

    Article  PubMed  PubMed Central  Google Scholar 

  6. Maffulli N, Papalia R, Zampogna B et al (2016) The management of osteomyelitis in the adult. Surgeon (in press)

  7. Walter G, Kemmerer M, Kappler C et al (2012) Treatment algorithms for chronic osteomyelitis. Dtsch Arztebl Int 109:257–264

    PubMed  PubMed Central  Google Scholar 

  8. Beck-Broichsitter BE, Smeets R, Heiland M (2015) Current concepts in pathogenesis of acute and chronic osteomyelitis. Curr Opin Infect Dis 28:240–245

    Article  CAS  PubMed  Google Scholar 

  9. Patzakis MJ, Rao S, Wilkins J et al (1991) Analysis of 61 cases of vertebral osteomyelitis. Clin Orthop Relat Res 264:178–183

    Google Scholar 

  10. Trudelle-Jackson E, Emerson R, Smith S (2002) Outcomes of total hip arthroplasty: a study of patients one year postsurgery. J Orthop Sports Phys Ther 32:260–267

    Article  PubMed  Google Scholar 

  11. Schenker ML, Yannascoli S, Baldwin KD et al (2012) Does timing to operative debridement affect infectious complications in open long-bone fractures? A systematic review. J Bone Joint Surg Am 94:1057–1064

    Article  PubMed  Google Scholar 

  12. Lentino JR (2003) Prosthetic joint infections: bane of orthopedists, challenge for infectious disease specialists. Clin Infect Dis 36:1157–1161

    Article  PubMed  Google Scholar 

  13. Tice AD, Hoaglund PA, Shoultz DA (2003) Risk factors and treatment outcomes in osteomyelitis. J Antimicrob Chemother 51:1261–1268

    Article  CAS  PubMed  Google Scholar 

  14. Conterno LO, Turchi MD (2013) Antibiotics for treating chronic osteomyelitis in adults. Cochrane Database Syst Rev 9:CD004439

    Google Scholar 

  15. Lin JC, Lin CS, Hsu CW et al (2016) Association between Parkinson’s disease and inflammatory bowel disease: a nationwide Taiwanese retrospective cohort study. Inflamm Bowel Dis 22:1049–1055

    Article  PubMed  Google Scholar 

  16. Wu SH, Chuang E, Chuang TY et al (2016) A nationwide population-based cohort study of migraine and organic-psychogenic erectile dysfunction. Medicine 95:e3065

    Article  PubMed  PubMed Central  Google Scholar 

  17. National Health Institute Research Database (NHIRD), Taiwan. Home page at: http://nhird.nhri.org.tw/en/index.html. Cited in 2015

  18. Weller TM, Smith PM, Crook DW (1994) Corynebacterium jeikeium osteomyelitis following total hip joint replacement. J Infect 29:113–114

    Article  CAS  PubMed  Google Scholar 

  19. Nagarajah K, Aslam N, McLardy Smith P et al (2005) Iliofemoral distraction and hip reconstruction for the sequelae of a septic dislocated hip with chronic femoral osteomyelitis. J Bone Joint Surg Br 87:863–866

    Article  CAS  PubMed  Google Scholar 

  20. Romanò CL, Logoluso N, Meani E et al (2014) A comparative study of the use of bioactive glass S53P4 and antibiotic-loaded calcium-based bone substitutes in the treatment of chronic osteomyelitis: a retrospective comparative study. Bone Joint J 96-B:845–850

    Article  PubMed  Google Scholar 

Download references

Author contributions

All authors have contributed substantially to, and are in agreement with the content of, the manuscript: Conception/design: Yun-Ping Lim, Dong-Zong Hung, Ni Tien; Provision of study materials: Yun-Ping Lim, Cheng-Li Lin; Collection and/or assembly of data: Yun-Ping Lim, Cheng-Li Lin; Data analysis and interpretation: Yun-Ping Lim, Cheng-Li Lin; Manuscript preparation: All authors; Final approval of manuscript: All authors. The guarantor of the paper, taking responsibility for the integrity of the work as a whole, from inception to published article: Yun-Ping Lim.

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    Authors and Affiliations

    1. Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan

      D.-Z. Hung

    2. Department of Emergency, Toxicology Center, China Medical University Hospital, Taichung, Taiwan

      D.-Z. Hung

    3. Department of Microbiology, Laboratory Medicine, China Medical University Hospital, Taichung, Taiwan

      N. Tien

    4. Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan

      C.-L. Lin

    5. Translational Medicine Research Center, Chia-Yi Christian Hospital, Chiayi, Taiwan

      Y.-R. Lee

    6. Department of Biomedical Informatics, Asia University, Taichung, Taiwan

      C. C. N. Wang

    7. Department of Pharmacy, Tajen University, Pingtung, Taiwan

      J.-J. Chen

    8. Department of Pharmacy, College of Pharmacy, China Medical University, No. 91, Hsueh-Shih Road, Taichung, 40402, Taiwan, Republic of China

      Y.-P. Lim

    9. Division of Endocrinology and Metabolism, Department of Medicine, China Medical University Hospital, Taichung, Taiwan

      Y.-P. Lim

    10. Department of Medical Research, China Medical University Hospital, Taichung, Taiwan

      Y.-P. Lim

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    1. D.-Z. Hung
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    Corresponding author

    Correspondence to Y.-P. Lim.

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    Funding

    This study was supported by the Ministry of Science and Technology, Taiwan, R.O.C. (MOST105-2320-B-039-031), China Medical University, Taichung, Taiwan (CMU105-ASIA-22), partially supported by the Taiwan Ministry of Health and Welfare Clinical Trial and Research Center of Excellence (MOHW105-TDU-B-212-133019), China Medical University Hospital, Academia Sinica Taiwan Biobank Stroke Biosignature Project (BM10501010037), NRPB Stroke Clinical Trial Consortium (MOST105-2325-B-039-003), Tseng-Lien Lin Foundation, Taichung, Taiwan, Taiwan Brain Disease Foundation, Taipei, Taiwan, and Katsuzo and Kiyo Aoshima Memorial Funds, Japan.

    Conflict of interest

    The authors declare no conflict of interest.

    Ethical approval

    Our study was exempt from full review by the Third Research Ethics Committee of China Medical University and Hospital (IRB registration number: CMUH-104-REC2-115 on April 23, 2015).

    Informed consent

    The NHIRD encrypts patient personal information to protect privacy and provides researchers with anonymous identification numbers associated with relevant claims information, including sex, date of birth, medical services received, and prescriptions. Therefore, patient consent is not required to access the NHIRD. This study was approved to fulfill the condition for exemption by the Institutional Review Board (IRB) of China Medical University (CMUH104-REC2-115). The IRB also specifically waived the consent requirement.

    Additional information

    D.-Z. Hung and N. Tien contributed equally to this work.

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    Cite this article

    Hung, DZ., Tien, N., Lin, CL. et al. Increased risk of chronic osteomyelitis after hip replacement: a retrospective population-based cohort study in an Asian population. Eur J Clin Microbiol Infect Dis 36, 611–617 (2017). https://doi.org/10.1007/s10096-016-2836-0

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    • DOI: https://doi.org/10.1007/s10096-016-2836-0

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