Presentation Abstract

Session: 001-015-Adult Reconstruction Hip I
Date/Time: Tuesday, Mar 11, 2014, 9:18 AM - 9:24 AM
Location Theater A
Presentation Number: Paper 011
Title: TJA Appears Cardioprotective in Patients with Moderate-severe OA: A Propensity-score Matched Landmark Analysis
Classification: +Primary THA (Hip)
Keywords: Total Hip Arthroplasty; Outcomes
Author(s): Bheeshma Ravi, MD, Toronto, Canada
Ruth Croxford, MSc, Toronto, Canada
Peter Austin, Toronto, Canada
Lorraine Lipscombe, Toronto, Canada
Arlene Bierman, MD, MS, Toronto, Canada
Paula Harvey, MBBS, PhD, Toronto, Canada
Gillian Hawker, MD, Toronto, Canada
Abstract: INTRODUCTION: Physical inactivity is a major risk factor for cardiovascular disease. A frequently cited reason for inactivity in older adults is osteoarthritis (OA). While hip and knee total joint arthroplasty (TJA) significantly improve walking ability in OA, the effect of TJA on rates of cardiac events and long-term survival in patients with OA has not been examined.
METHODS: The study utilized a cohort of 2,200 individuals with hip/knee OA aged 55+ years at recruitment (1996-1998) and followed prospectively until death or 2011. Using a propensity-score matched landmark analysis, the rates of a composite outcome (serious cardiac event or death) and survival were compared for those who did versus did not receive a primary TJA within an exposure period of three years following their baseline assessment.
RESULTS: The propensity-score matched cohort consisted of 162 matched pairs of subjects with moderate-severe arthritis. Over the follow-up period, matched participants who received a TJA during the exposure period were significantly less likely to experience the composite outcome than those who did not [HR 0.63, 95%CI 0.49-0.82, p=0.0005]. The absolute risk reduction and number needed to treat within seven years of the exposure period were 13.6% (95%CI 3.3-23.9) and eight patients (95%CI 4-30), respectively.
DISCUSSION AND CONCLUSION: Using a propensity-matched landmark analysis in a population cohort with advanced hip/knee OA, this study documented a cardio-protective benefit of receipt of a primary, elective TJA.The most likely explanation for our findings is that TJA improves capability for physical activity. Moderate-intensity physical activity (e.g., a brisk walk) a few days a week has direct benefits for hypertension, obesity and diabetes, which are highly prevalent in individuals with OA, and known to increase risk for CVD. These findings provide further support for interventions designed to reduce physical inactivity due to OA.

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