Background/Purpose: Potential beneficial effect of statin use on osteoarthritis progression is discussed. some studies have suggested that statins may have a protective effect on structural evolution, others did not show any protective effect and few studies showed a deletitious effect. The aim of our study was to assess the risk of total knee or hip replacement among patients treated by statin versus patients without statin treatment in the French population

Methods: We conducted a nationwide population based cohort study using the french national healthcare system database (SNDS). We included all subjects starting a statin treatment in 2018 and still on treatment on a regular basis until december 2022 and 800,000 unexposed subjects randomly selected from the entire French population. Concerning the statin group, subjects with statin in 2017 were excluded to permit to have only incident use of statins and subjects need to have at least 3 dispensation per year by pharmacy to be sure that statin were taken correctly. The primary endpoints, occurrence of knee or hip arthroplasty, were studied using Cox models adjusted for age, gender and comorbidities. In order to assess the uncertainty around the results and to limit indication biais, a propensity score matching was performed in a sensitivity analysis to create 2 groups of comparable patients.

Results: Out of the nearly 66 millions of subjects in the data base. The cohort included 274,801 patients treated with statins and 795,491 patients without statins, after removing patients who met exclusion criteria. Mean age 60.2 and 56.1 years, female 41.9 % and 51.9 %, diabetis 24.0 % and 7.7 %, cardiovascular comorbidities 33.0 % and 7.0 % respectively. During follow-up 5,788 and 9,928 knee replacement and 5,347 and 10,170 hip replacement occured in the statin and non statin group, respectively. Risk of knee or hip replacement for the statin group versus non statin group was significantly higher : knee replacement HR 1.49 [1.44 ; 1.55] (p< 0.0001) ; hip replacement HR 1.39 [1.34 ; 1.44] (p< 0.0001). The results were confirmed by sensitivity analysis using a propensity score with still a higher risk about 22% for both joints.

Conclusion: This study showed that statin use is associated in a increased significant risk of knee and hip replacement.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/statin-use-and-risk-of-total-joint-replacement-of-knee-and-hip-in-osteoarthritis-patients-study-based-on-the-french-national-health-insurance-cohort/