{
  "abstract": "Objective: Hyperlipidaemia is common in knee and hip replacement patients, with nearly half untreated. Elevated low-density lipoprotein cholesterol (LDL-C) has been associated with postoperative pain and prosthetic joint infections; however, the impact of LDL-C lowering on revision surgery remains unclear. We aimed to examine the association between pragmatic LDL-C management strategies, operationalized according to LDL-C target attainment during the 1-year grace period, and the risk of revision among patients with hyperlipidaemia undergoing knee and hip replacement.\n\nMethods: Using The Health Improvement Network database, we identified knee and hip replacement patients with hyperlipidaemia aged 40 years or older initiating LDL-C-lowering medications. We emulated a hypothetical target trial to compare the 5-year revision risk between pragmatic LDL-C management strategies, with adherence to the goal-based strategy operationalized as having an LDL-C level <3 mmol/L during the 1-year grace period.\n\nResults: Among 28,756 qualified participants, the 5-year revision risk was lower in those achieving the target LDL-C level (2.35%) compared to those not achieving it (2.76%), with a risk difference of −0.41% (95%CI: −0.72% to −0.09%), and a hazard ratio (HR) of 0.74 (95%CI: 0.61 to 0.90). For knee replacement revision, the 5-year risk difference was −0.47% (95%CI: −0.91% to −0.09%), with an HR of 0.69 (95%CI: 0.51 to 0.92). For hip replacement revision, the 5-year risk difference was −0.28% (95%CI: −0.80% to 0.20%), with an HR of 0.80 (95%CI: 0.63 to 1.01).\n\nConclusion: Adherence to a goal-based LDL-C management strategy, operationalized as having an LDL-C level <3 mmol/L during the 1-year grace period, was associated with a lower risk of revision surgery among patients with hyperlipidaemia undergoing joint replacement, especially after knee replacement.\n\nThe translational potential of this article: This study highlights postoperative lipid management as a potentially modifiable component of joint replacement care. If confirmed in future prospective studies, strategies to achieve guideline-recommended LDL-C targets may be considered as part of routine postoperative management to potentially improve long-term outcomes following joint replacement.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China",
    "Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China",
    "Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital, Central South University, Changsha, China",
    "Key Laboratory of Aging-related Bone and Joint Diseases Prevention and Treatment of Ministry of Education, Xiangya Hospital, Central South University, Changsha, China",
    "Department of Clinical Sciences Lund, Orthopaedics, Clinical Epidemiology Unit, Lund University, Lund, Sweden",
    "Center for Musculoskeletal Health and Department of Medicine, University of California School of Medicine, Sacramento, CA, USA",
    "Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA",
    "The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, USA",
    "Department of Hematology and Critical Care Medicine, Third Xiangya Hospital, Central South University, Changsha, China",
    "Key Laboratory of Sepsis Translational Medicine of Hunan, Central South University, Changsha, China",
    "FuRong Laboratory, Changsha, Hunan, China",
    "National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 11,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Wei Li"
    },
    {
      "affs": [
        1,
        0
      ],
      "name": "Yadan Xiao"
    },
    {
      "affs": [
        0,
        2,
        3
      ],
      "name": "Dongxing Xie"
    },
    {
      "affs": [
        4
      ],
      "name": "Martin Englund"
    },
    {
      "affs": [
        5
      ],
      "name": "Nancy E. Lane"
    },
    {
      "affs": [
        6,
        7
      ],
      "name": "Yuqing Zhang"
    },
    {
      "affs": [
        0,
        2,
        3
      ],
      "name": "Yilun Wang"
    },
    {
      "affs": [
        8,
        9
      ],
      "name": "Kai Zhao"
    },
    {
      "affs": [
        0,
        1,
        2,
        3,
        10
      ],
      "name": "Jie Wei"
    },
    {
      "affs": [
        0,
        2,
        3,
        10,
        11
      ],
      "name": "Guanghua Lei"
    },
    {
      "affs": [
        0,
        1,
        2,
        3,
        11
      ],
      "name": "Chao Zeng"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/5tehrhzxqj8v1.bib",
  "cited_by": 0,
  "doi": "10.1016/j.jot.2026.101223",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13696762/",
  "id": "5tehrhzxqj8v1",
  "issns": [
    "2214-031X",
    "2214-0328"
  ],
  "landing_url": "https://doi.org/10.1016/j.jot.2026.101223",
  "language": "en",
  "licence": "CC-BY-NC-ND-4.0",
  "licence_label": "CC BY-NC-ND 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Original Article"
    ],
    [
      "openalex",
      "2746|Lipoproteins and Cardiovascular Health"
    ]
  ],
  "openalex": "W7222838022",
  "pdf_url": "https://europepmc.org/articles/PMC13696762?pdf=render",
  "pmcid": "PMC13696762",
  "pmid": "42935702",
  "published": "2026-10-17",
  "publisher": "Chinese Speaking Orthopaedic Society",
  "ris": "https://research.draconitic.com/paper/5tehrhzxqj8v1.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:18:03Z",
      "native_id": "PMC13696762",
      "source": "pmc",
      "url": "https://doi.org/10.1016/j.jot.2026.101223"
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    {
      "first_seen": "2026-10-30T12:22:12Z",
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  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2746|Lipoproteins and Cardiovascular Health",
      "subfield": "surgery"
    }
  ],
  "title": "LDL-C target attainment and risk of revision following knee and hip replacements: real-world evidence from a target trial emulation study",
  "title_text": "LDL-C target attainment and risk of revision following knee and hip replacements: real-world evidence from a target trial emulation study",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:34:02Z",
  "url": "https://research.draconitic.com/paper/5tehrhzxqj8v1",
  "venue": "Journal of Orthopaedic Translation",
  "versions": []
}