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Effect of Oral Direct Factor Xa Inhibitors on the Prevalence of Hip Heterotopic Ossification Following Arthroplasty for Femoral Neck Fracture: A Propensity Score-Matched Cohort Study
Background: Heterotopic ossification (HO) is a common complication following hip arthroplasty that can limit hip range of motion (ROM). Oral direct factor Xa inhibitors are commonly used anticoagulants after arthroplasty; however, they have a high risk of local bleeding and hematoma formation, which are significant triggers for HO formation. To our knowledge, there is no evidence regarding whether FXa inhibitors use will increase HO incidence following hip arthroplasty.
Methods: This retrospective, observational, propensity-score-matched (PSM) cohort study was conducted at the National Orthopedics Clinical Medical Center in Shanghai, China, spanning from January 1, 2019, to November 30, 2023. Totally 944 patients who underwent hip arthroplasty following femoral neck fracture were included. The present study excluded patients with central nervous system injury, spinal cord injury, burns or destructive injury; those with multi-part injuries or fractures; those with postoperative complications such as surgical field infection and dislocation; those with a history of hip surgery or trauma; and those who refused to participate in the study or had been lost to follow-up. Following 1:1 propensity score matching based on sex, age, BMI, injury side, and NSAIDs use, the FXa inhibitors group and the no-FXa inhibitors group each consisted of 362 patients. All patients received low-molecular-weight-heparin (LMWH) during hospitalization but no other anticoagulants.
Results: In the PSM population, the incidence of HO was 29.2% in the FXa inhibitors group and 15.7% in the no-FXa inhibitors group (7.7% and 2.4% for clinically important HO, respectively). Logistic regression analyses revealed that FXa inhibitors usage was significantly associated with a higher rate of HO (odds ratio [OR], 2.22; 95% CI, 1.55 to 3.20; p < 0.001) compared to no-usage. Additionally, FXa inhibitors use was also linked to an increased risk of clinically significant HO (OR, 3.29; 95% CI, 1.59 to 7.48; p = 0.002). None of the baseline covariates demonstrated a significant influence on the association between FXa inhibitors use and HO incidence (p > 0.05 for all). Sensitivity analyses further corroborated these results.
Conclusions: Direct factor Xa inhibitors use may be a new risk factor of HO development following hip arthroplasty for femoral neck fracture.
Keywords: Oral factor Xa inhibitors, Hip arthroplasty, Heterotopic Ossification, Femoral neck fracture
Chen, Zhenyu and Xu, Yi and Liu, Hang and Luo, Gang and Yuan, Zhengqiang and Cai, Zhuochang and Wang, Wei and Li, Juehong and Sun, Ziyang and Fan, Cunyi, Effect of Oral Direct Factor Xa Inhibitors on the Prevalence of Hip Heterotopic Ossification Following Arthroplasty for Femoral Neck Fracture: A Propensity Score-Matched Cohort Study. Available at SSRN: https://ssrn.com/abstract=5112756 or http://dx.doi.org/10.2139/ssrn.5112756
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