Study Shows Total Joint Replacements Reduce Risk of Cardiac Events

Researchers in Toronto have conducted a study that suggests total hip or knee replacements may reduce the risk for cardiovascular events in patients with osteoarthritis. The study, which appeared in British Medical Journal, indicates that currently osteoarthritis is associated with increased mortality, particularly secondary to cardiovascular disease. The risk for mortality is proportional to the degree of disability secondary to osteoarthritis. Increased use of non-steroidal anti-inflammatory drugs and psychosocial stress in people with osteoarthritis may exacerbate this risk, which may at first glance suggests that major surgery such as a total joint replacement may increase the risk of cardiac events. However, the study found otherwise.

The University of Toronto researchers selected 153 people with moderate to severe osteoarthritis who had had a knee or hip replacement and 153 who had not. The groups were matched for severity of arthritis, age, income, smoking status, diabetes and other factors. The researchers followed them for seven years, during which there were 111 instances of a serious cardiovascular event—heart attack, stroke, heart failure, coronary artery bypass surgery, angioplasty or death from cardiovascular disease. Researchers found that elective primary total knee arthroplasty within three years of initial assessment was associated with a 54 percent reduction in subsequent risk of serious cardiovascular events in people with moderate-severe osteoarthritis; for total hip arthroplasty, the reduction was 39 percent.

The researchers speculated on what may have caused the reduction in risk, but to not have a conclusive answer.

“Debilitating arthritis limits the ability to exercise, which in turn leads to worse outcomes for the heart,” said lead author Bheeshma Ravi, M.D., a resident in orthopedic surgery at the University of Toronto. “A joint replacement reduces pain and inflammation and even depression, all risk factors for cardiac events.”

“If [patients] care enough about their musculoskeletal health to go through the pain and suffering of a total joint replacement to try to get better, they’re quite possibly the same people who are trying to walk a mile-and-a-half a day and lose weight and eat appropriately, which is really hard to capture,” Trevor Murray, M.D, an orthopedic surgeon at Cleveland Clinic in Cleveland, Ohio told the Arthritis Foundation. He also said that the “whole point” of surgery is to reduce pain, which may also contributed to the reduced heart stress.