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The relation between total joint arthroplasty and risk for serious cardiovascular events in patients with moderate-severe osteoarthritis: propensity score matched landmark analysis

BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f6187 (Published 30 October 2013) Cite this as: BMJ 2013;347:f6187
  1. Bheeshma Ravi, resident physician123,
  2. Ruth Croxford, epidemiologist4,
  3. Peter C Austin, senior scientist24,
  4. Lorraine Lipscombe, assistant professor235,
  5. Arlene S Bierman, associate professor2456,
  6. Paula J Harvey, scientist35,
  7. Gillian A Hawker, professor23457
  1. 1Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Canada
  2. 2Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
  3. 3Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
  4. 4Institute for Clinical Evaluative Sciences, Toronto, Canada
  5. 5Department of Medicine, University of Toronto, Canada
  6. 6Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Canada
  7. 7Division of Rheumatology, Department of Medicine, Women’s College Hospital, Toronto, Canada
  1. Correspondence to: B Ravi, Women’s College Hospital, 76 Grenville Street, 6th Floor, Room 6327, Toronto, ON M5S 1B2, Canada bheeshma.ravi{at}mail.utoronto.ca
  • Accepted 23 September 2013

Abstract

Objective To examine whether total joint arthroplasty of the hip and knee reduces the risk for serious cardiovascular events in patients with moderate-severe osteoarthritis.

Design Propensity score matched landmark analysis.

Setting Ontario, Canada.

Participants 2200 adults with hip or knee osteoarthritis aged 55 or more at recruitment (1996-98) and followed prospectively until death or 2011.

Main outcome measure Rates of serious cardiovascular events for those who received a primary total joint arthroplasty compared with those did not within an exposure period of three years after baseline assessment.

Results The propensity score matched cohort consisted of 153 matched pairs of participants with moderate-severe arthritis. Over a median follow-up period of seven years after the landmark date (start of the study), matched participants who underwent a total joint arthroplasty during the exposure period were significantly less likely than those who did not to experience a cardiovascular event (hazards ratio 0.56, 95% confidence interval 0.43 to 0.74, P<0.001). Within seven years of the exposure period the absolute risk reduction was 12.4% (95% confidence interval 1.7% to 23.1%) and number needed to treat was 8 (95% confidence interval 4 to 57 patients).

Conclusions Using a propensity matched landmark analysis in a population cohort with advanced hip or knee osteoarthritis, this study found a cardioprotective benefit of primary elective total joint arthroplasty.

Footnotes

  • Contributors: BR is the guarantor. The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by the Institute for Clinical Evaluative Sciences or the Ontario Ministry of Health and Long-Term Care is intended or should be inferred. All authors were involved in study conception and gave final approval for the submission. GAH created the clinical cohort that served as the information source for the study. BR, RC, PCA, and GAH were involved with the study design and statistical analysis. BR and GAH wrote the initial draft and were responsible for subsequent modifications based on feedback from the other authors and from the reviewers.

  • Funding: This study was supported by the Institute for Clinical Evaluative Sciences, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care. The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by the Institute for Clinical Evaluative Sciences or the Ontario Ministry of Health and Long-Term Care is intended or should be inferred. BR is supported in part by a doctoral award from the Canadian Institutes of Health Research. PCA is supported in part by a career investigator award from the Heart and Stroke Foundation. GAH is supported in part by the FM Hill chair in academic women’s medicine, and Canadian Institutes of Health Research grant No MOP-15468. ICES received support from the Ministry of Health and Long-Term Care.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: This study was approved by the Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.

  • Data sharing: No additional data available.

  • Transparency: BR affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/.

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