joint replacement cardiovascular side effects

Joint Replacement May Help Your Heart

Replacing damaged joints gives people with arthritis a dramatically improved quality of life – with reduction or even elimination of pain and improved mobility. A new joint can give you a new lease on life, allowing you to resume activities you love and improve your mood and relationships. But like anything in life, there are risks and benefits. A group of studies about the effects of joint replacement on your heart demonstrate those risks and benefits.

Studies published in recent years,  suggested that certain people are at increased risk of heart trouble following joint surgery. For example, a study in Annals of the Rheumatic Diseases in 2011 found an increased risk for cardiac complications following joint replacement surgery in older patients and in those who had pre-existing heart disease, deep vein thrombosis or pulmonary embolism. And a 2012 study published in Archives of Internal Medicine found that hip and knee replacement surgery boosts the risk of heart attack  during the first two weeks after surgery, particularly in patients older than 60.

“The increased risk [of heart attack following joint replacement surgery] is probably the result of both the stressful time during the perioperative period, as well as a direct effect of and surgery itself,” says Arief Lalmohamed, study author and researcher in the department of pharmaceutical sciences at Utrecht University in the Netherlands. Such effects as loss of blood, irregular heartbeats, and a reduction in oxygen getting to the heart can put a person at risk of heart attack. These effects are associated with other major surgeries as well, not just joint surgeries.

Simply being disabled by a hip or a joint that needs to be replaced can increase your risk of cardiovascular events, compared with those who aren’t disabled. “It is therefore very plausible that joint replacement may reduce long-term cardiovascular risk in these patients,” Lalmohamed said after his 2013 study was released. “It is important to stress that although there are some short-term risks with these major surgeries, the long-term benefit is well established and should be taken into account when discussing risks and benefits.”

A 2013 study published in the journal BMJ confirmed Lalmohamed’s statement about potential long-term heart benefits. This study found that people who undergo hip or knee replacement have reduced risks of heart attack, stroke and other cardiovascular events over time.

Study author Bheeshma Ravi, MD, previously in the division of orthopaedic surgery at University of Toronto, said “Our study suggested that in persons with moderate to severe osteoarthritis of hip or knee, joint replacement was associated with a greater than 40 percent reduction in the risk for serious cardiovascular events such as heart attack and stroke,” compared with similar patients who didn’t have surgery.

For the study, Dr. Ravi and colleagues looked at adults with moderate to severe hip or knee osteoarthritis. They matched 153 patients with knee or hip pain who went on to receive a joint replacement with 153 who did not, pairing people who had similar health profiles in terms of age, weight, smoking status, arthritis severity, etc. Then they looked at the rate of serious cardiac events, including heart attack, heart failure and stroke, in both groups over a period of seven years.

They found knee replacements were associated with a 54 percent reduction in heart risk, and hip replacements with a 39 percent reduction, says Dr. Ravi.

The researchers say they don’t know what caused the reduction in risk, but they speculate that the joint replacement enabled patients to increase their physical activity, which is good for the heart for many different reasons. Another factor could be less use of nonsteroidal anti-inflammatory drugs (NSAIDs), which are known to increase the risk of heart attack and stroke when taken long-term. Less stress due to pain may also play a role.

The authors acknowledge that the study has some limitations. “There is a selection bias towards offering elective surgery to healthier patients,” says Dr. Ravi. But the researchers tried to control for this bias. “We did a separate analysis where we only looked at patients that had at least one risk factor for cardiovascular events,” such as pre-existing cardiovascular disease, diabetes or hypertension, Dr. Ravi says. “We found that arthroplasty [joint replacement] still had a protective benefit, with a reduction in risk of about 30 percent.”

Prospective surgical patients concerned about heart risks ought to talk with their doctors to put the information into perspective, says Thomas Vail, MD, chair of orthopedic surgery, University of California San Francisco.

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