Effects of Perioperative Proton Pump Inhibitor Use on Outcomes of Total Joint Arthroplasty Patients Who Have Osteoporosis and Osteopenia.

Abstract

Proton pump inhibitors (PPIs) are commonly prescribed for gastrointestinal prophylaxis after total joint arthroplasty (TJA) during periods of increased nonsteroidal anti-inflammatory drug/aspirin use. However, studies have shown negative effects of PPIs on osseointegration, potentially leading to increased risk of implant-related complications, particularly among patients who have decreased bone density. The present investigation utilizes a large national database to compare outcomes between osteoporotic/osteopenic TJA patients who received routine prophylactic perioperative PPIs and those who did not. A retrospective review of patients who have osteoporosis/osteopenia undergoing total hip/knee arthroplasty (THA/TKA) in the database was performed. Long-term preoperative users of PPIs were excluded. Patients were classified based on whether or not they filled a PPI prescription perioperatively (30 days preoperatively to seven days postoperatively). The PPI and no-PPI groups were 1:1 propensity-score matched, and outcomes were compared at two and five years postoperatively. In the THA analysis, 3,370 patients were included in each group after matching. In the TKA analysis, 7,521 patients were included in each group. In THA patients, the all-cause revision rate was 3.6% at two years and 4.4% at five years. At two and five years, both groups experienced similar rates of revision, aseptic loosening/mechanical failure, periprosthetic fracture, dislocation/instability, surgical site infection (assessed at two years only), and periprosthetic joint infection (assessed at two years only). In TKA patients, the all-cause revision rate was 2.4% at two years and 3.7% at five years. There were no significant differences in outcomes observed between groups at two or five years postoperatively. In osteopenic and osteoporotic patients undergoing TJA, rates of 2- and 5-year postoperative complications were low and similar among patients who used PPIs perioperatively and those who did not. The short-term use of PPIs for gastrointestinal prophylaxis after TJA appears safe among this higher risk population, but further study is warranted to evaluate long-term outcomes.