Physical inactivity and non-steroidal anti-inflammatory drug (NSAID) use are established risks for serious cardiovascular events.\u00a0 Osteoarthritis can contribute to these risk factors by reducing patient mobility and NSAID use for symptom relief.\u00a0 Using data from a registry of patients with moderate-severe osteoarthritis, Ravi and colleagues evaluated the relationship between total joint arthroplasty of the hip and knee and subsequent risk for serious cardiovascular events.<\/p>\n
Using a propensity score matched landmark analysis design with a median follow-up of seven years, the authors compared outcomes among patients that underwent total joint arthroplasty with those who did not.\u00a0 The primary outcome of serious cardiovascular event included acute myocardial infarction, stroke or transient ischemic attack, congestive heart failure, coronary revascularization, or in-hospital cardiac death.\u00a0 The authors found patients that underwent total joint arthroplasty were at a significantly reduced risk for serious cardiovascular events (hazard ratio 0.56; 95% CI 0.43 to 0.74; P < 0.001).\u00a0 This corresponded to an absolute risk reduction of 12.4% (95% CI 1.7% to 23.1%) and a number needed to treat of 8 (95% CI 4 to 57).\u00a0 Given the observational nature of the study, the investigators evaluated the potential impact of unmeasured confounders on the findings.\u00a0 This analysis demonstrated the primary results are robust as an unmeasured confounder would need a very high prevalence (75%) and strong association with the outcome (relative risk of 66%) to negate the observed findings. <\/b><\/p>\n
Conclusions:<\/b> This study strongly suggests that joint replacement has a significant effect on future cardiovascular events in patients with osteoarthritis.\u00a0 However, it is unclear if this benefit is predominantly related to improved physical activity, reduced use of NSAIDs after surgery, or other factors.\u00a0 Understanding the predominant mediator of these findings would further guide the optimal approach to all patients with osteoarthritis to reduce cardiovascular risk.<\/p>\n