Propranolol Reduces Risk of Knee or Hip Replacement Due to Osteoarthritis: a Propensity Score Matched Cohort Study-using Data From the Clinical Practice Research Datalink.

Abstract Objectives To examine the association between β-blocker prescription and knee or hip total joint replacement (TJR) in a UK primary-care population with incident knee or hip osteoarthritis (OA).Methods Cohort study using data from the Clinical Practice Research Datalink. Participants aged ≥40 years with incident knee or hip OA, exposed to β-blockers after OA diagnosis (new-user design), were matched to one control for age, sex, OA location and propensity score (PS) for β-blocker prescription. Cox-proportional hazard ratios (HRs) and 95% confidence intervals (CI) were calculated. The analyses were adjusted for factors that influence health-seeking behaviour, progression of OA, and stratified according to β-blocker classification. Data analysis was conducted using Stata.Results Data for 6,970 PS-matched β-blocker exposed and unexposed participants were included. Any β-blocker prescription was not associated with knee or hip TJR (aHR 1.11; 95% CI 0.98 – 1.25). However, prescription of lipophilic non-selective β-blockers having membrane stabilising effects associated with reduced risk of knee or hip TJR (aHR 0.69; 95% CI 0.52 – 0.93). Of these, there was a protective effect for propranolol (aHR 0.71; 95% CI 0.53 – 0.95), the commonest prescribed drug in this class. The number needed to treat (95% CI) with propranolol for two years in order to prevent one TJR was 32 (23-52).Conclusion Propranolol, a non-selective β-blocker, reduces the risk of knee and hip TJR. This is consistent with its analgesic effects in other conditions and a randomised controlled trial is required to further evaluate its analgesic potential and safety in OA.