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Study links joint replacement surgery to lower cardiovascular risks in osteoarthritis patients

Oct. 31, 2013

Osteoarthritis patients who have joint replacement surgery may have lower risks of heart attack and stroke. Results of a new study led by Women’s College Research Institute (WCRI) scientists show that those who had hip or knee replacement surgery had lower rates of serious cardiovascular events than other patients with moderate to severe osteoarthritis.

Osteoarthritis is the most common form of arthritis, and a major cause of disability. The study authors note that disability from osteoarthritis has been linked to higher risk of death, especially from cardiovascular disease. Total joint replacement surgery (hip or knee replacement) can improve pain, mobility and quality of life in osteoarthritis patients. Because the surgery can reduce disability, researchers wanted to test whether it may also be linked to improved heart and stroke risks.

The results of the study showed that patients who had hip or knee replacement surgery reduced their risk of events such as heart attack and stroke by 12.4 per cent.

The researchers offer some possible reasons for these reduced risks. Total joint replacement can improve a patient’s physical abilities, such as walking. This can improve their physical activity level, which is linked to cardiovascular health.

The surgery may also help lower stress, which is a cardiovascular risk factor. Because total joint replacement can reduce the pain of osteoarthritis, it may also relieve the stress associated with being in chronic pain.

Another benefit of reduced pain is reduced use of pain relievers known as NSAIDs (non-steroidal anti-inflammatory drugs). NSAIDs have been linked to higher risk of cardiovascular events.

For the study, researchers at WCRI, the University of Toronto and Institute for Clinical Evaluative Sciences used information on 2,200 patients with moderate to severe hip or knee osteoarthritis. All the patients lived in Ontario, and were age 55 or older at the start of the study. Health information was collected from all 2,200 patients when they enrolled in the study, between 1996 and 1998. The researchers then identified all of the patients who had total joint replacement surgery within three years of joining the study.

There were 153 patients who had knee or hip replacement surgery within three years. To make sure they were comparing similar patients, the researchers matched the surgery patients with non-surgery patients. Each patient who had total joint replacement was matched to another patient of the same age and sex, who had similar health issues and similar osteoarthritis symptoms, but who did not have the surgery.

The researchers followed the 153 surgery patients and the 153 matched non-surgery patients for a further seven years. Then they compared the results in the two groups.

The rates of serious cardiovascular events were significantly lower in the group that had had total joint replacement surgery. Serious cardiovascular events included heart attack, stroke, bypass surgery and dying of cardiovascular causes while in hospital. The risk of these events was reduced by 12.4 per cent in the surgery patients, compared to those who did not have the surgery. The researchers calculated that for every eight patients who have total joint replacement surgery, one cardiovascular event may be prevented.

Although they need to be confirmed in a larger study, these results encourage greater focus on how reducing disability in osteoarthritis patients may help control or prevent other health conditions.

The study was published online in BMJ on Oct. 30, 2013.


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  • A publication of:
  • Women's College Hospital