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However, its impact on long-term all-cause-mortality is inconclusive. Study aims: Investigate 20-year all-cause-mortality in patients with hip\/knee arthroplasty (recruited 1995\/1996, N\u2009=\u2009809) from the Ulm Osteoarthritis Study-cohort, in comparison to general population. Furthermore, to enlighten the triangle between baseline life-style and cardio-metabolic risk factors, phenotypic OA-patterns (laterality, generalization, cause) and all-cause-mortality. Mortality was assessed during 20 years follow-up. Standardized mortality ratios (SMR), adjusted odds ratios and hazard ratios (aHR) were calculated. After five years cohort-mortality was reduced compared to the general population, however 20 years later assimilated (SMR\u2009=\u20091.11; 95%-CI 0.73-1.49). OA-patterns were associated with age, cholesterol, and overweight\/obesity. In comparison to primary OA decreased mortality was observed for patients with secondary OA (aHR\u2009=\u20090.76; 95%-CI 0.61-0.95) adjusted for age, smoking, overweight\/obesity, diabetes, hypertension, cardiac insufficiency, uric acid, and lower cholesterol. There was no increased mortality in patients after 20 years follow-up compared to general population. Significantly decreased mortality in secondary compared to primary OA suggests a subtype-specific involvement of systemic co-factors in determination of all-cause-mortality. Because cardio-metabolic risk factors were associated with increased risk of bilateral OA and lower long-term survival, those risk factors should be consequently targeted in OA-patients.<\/jats:p>","DOI":"10.1038\/s41598-018-23573-2","type":"journal-article","created":{"date-parts":[[2018,3,29]],"date-time":"2018-03-29T01:52:53Z","timestamp":1522288373000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Osteoarthritis-patterns, cardio-metabolic risk factors and risk of all-cause mortality: 20 years follow-up in patients after hip or knee replacement"],"prefix":"10.1038","volume":"8","author":[{"given":"G.","family":"B\u00fcchele","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K. 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