Statin Exposure and Risk of Prosthetic Joint Infection After Total Knee or Hip Arthroplasty Among U.S. Veterans.

Abstract Background Statins have a variety of pleiotropic effects that could be beneficial for patients undertaking total knee or hip arthroplasty. In vitro and in vivo models suggest the beneficial effects of statins through bone formation and modulating proinflammatory cytokines triggered by implant debris. However, statins also exhibit antimicrobial action and may reduce the risk of revision surgery via reducing the risk of infection. We sought to explore the relationship between statin use and prosthetic joint infection (PJI) after total knee or hip arthroplasty. Methods We use a retrospective cohort of patients undergoing total knee or hip arthroplasty performed within the Department of Veterans Affairs. To minimize selection bias between the statin exposed and unexposed patients, we used 1:1 ratio propensity score matching. We fit adjusted Cox proportional hazards models to quantify the risk of PJI between the cohorts within 1 year, 3 years, and all follow-up time. Results With a study period beginning from January 2000, a total of 60,241 patients were included. The unmatched Cox models reveal, over the entire follow-up time, a statistically significant lower risk of infection for the statin exposed patients (hazard ratio = 0.869; 95% confidence interval = [0.79-0.956]). The matched Cox model results reveal a statistically significant lower risk of PJI, only in the overall model, for the statin exposed cohort compared with the unexposed cohort (hazard ratio = 0.895, 95% confidence interval = [0.807-0.993]). Conclusion Our analysis finds some support for the beneficial effects of statins for preventing PJI among patients undergoing total knee or hip arthroplasty.