Helping the Heart and Hips, Too

It is a well-known fact that cholesterol-lowering statins can benefit people with heart disease. Now there is evidence these drugs also can help patients who undergo total hip replacements.

A study published in the May 2010 issue of The Journal of Bone and Joint Surgery (JBJS) found that statins substantially reduced the risk of revision hip surgery. Using data in the Danish Hip Arthroplasty Registry, researchers studied the medical histories of 2,349 patients who needed hip replacement revision surgeries over a 10-year period and compared them with hip replacement patients of the same age and sex who did not need the second procedure.

Overall, any patient in the registry had an 8.9 percent risk of needing a fix or a replacement for their new joint. That risk, however, fell by 66 percent among those who took statin medications, giving them a risk of revision of just 5.9 percent, the data showed.

“The survival of a hip implant is related to many different mechanisms,” said Dr. Theis Thillemann, M.D., the study’s author and a fellow in the Department of Orthopaedic Surgery, Aarhus University Hospital in Denmark. “Statins have been associated with improved bone metabolism, improved anti-inflammatory effects and improved prognosis after infections.”

Thillemann claims the drugs may help improve the outcomes of hip replacement surgery by:

•Encouraging bone formation, which may improve the fixation of the implant to the bone;
•Reducing inflammation, which can cause the implant to loosen; and
•Reducing the rate of infections at the implant site.

Though they are encouraged by the results of the study, researchers cannot categorically conclude that statin use leads to a reduced risk of hip revision surgery. There are still too many unknowns, they say. For instance, people who take statins tend to be more concerned and conscientious about their health and may have instituted other lifestyle changes that help reduce their risk of infections or fractures. Such changes are difficult to detect in a study.

Thillemann said future research will help doctors determine whether statins should be prescribed to healthy patients before they undergo total hip replacements. Any general recommendation of statin use in hip replacement patients depends on several factors, Thillemann noted, including:

•the association between statin use and the risk of revision;
•the effect and safety of statin therapy on other existing medical conditions; and
•the price of statin therapy.

“For now, our findings are very positive for patients who are receiving statins due to other diseases,” Thillemann said. “Further research is necessary before statins can be recommended for otherwise healthy patients undergoing hip replacement surgery.”

Still, many patients that undergo hip replacement surgery may take statins for cardiovascular disease or diabetes. Doctors treating these patients should keep in mind that the drugs may benefit their new joints, Thillemann noted.