New Knees and Hips Cut Heart Risk

Heart DiseaseAt the annual meeting of the American Academy of Orthopedics in New Orleans, Bheeshma Ravi, M.D., an orthopedics resident at the University of Toronto, reported that patients who underwent knee and hip replacements were able to dramatically reduce their risk of a heart attack or stroke over a seven year period. He followed 153 patients who were high risk for cardiovascular disease and noted the major risk reduction.

Some of the improvement in risks were assumed to be due to the increased mobility and increased activity the recipients were able to enjoy. The increased physical activity improves cardiac health. While physical activity is one explanation, the reduction in pain, stress, use of painkillers and inflammation is another set of potential reasons. With pain comes use of more nonsteroidal anti-inflammatory medications which have been implicated in the development of acute heart attacks.

In our medical practice we often see senior citizens who are healthy enough to undergo a joint replacement but are too fearful to proceed with the surgery. This particular study provides additional evidence that replacing the inflamed joint and resuming activity is the correct choice to make.

Metal Joint Replacement – Should Allergy Testing Be Done First?

As our physically active baby boomers age, more and more of them are facing the need for joint replacement. We run, golf, bike and attend exercise class all in the name of fitness and cardiovascular health.  As a result, many of us have bodies that are becoming beat up and worn.

There have been numerous articles discussing the large increase in knee and hip replacements in active 50 year olds who wish to continue to be as active as they were prior to joint replacement surgery.  An article appeared in this week’s MedPage online journal about a small Italian study conducted regarding chronic pain in “successful “metal joint replacements in the lower extremity. Most of us know someone who had a perfectly unremarkable uncomplicated knee or hip replacement who is now suffering from unexplained pain at the surgically repaired joint site.  X Rays show perfect alignment. CT Scans and MRI scans show perfect surgical alignment. The patient remains in pain.

The study released by Italian researchers’ discusses allergic contact allergy being the cause of the continued pain. The individuals evaluated are allergic to the metals in the artificial joint. In the study subjects were patch tested in advance of joint replacement. Those showing allergic sensitivity to metals contained in the prosthesis received a hypoallergenic product instead. They did not develop the unexplained pain and discomfort and had a great outcome. While the study was small and the results preliminary, it raises the question of whether allergy patch testing prior to elective joint replacement should, and will, become the norm in the future.