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

Nakafero, Georgina; Grainge, Matthew J; Valdes, Ana M; Townsend, Nick P; Mallen, Christian; Zhang, Weiya; Doherty, Michael; Mamas, Mamas A; Abhishek, Abhishek

Abstract

Background:
There is paucity of safe and effective analgesic drugs for osteoarthritis (OA). β-adrenoreceptor blockers have demonstrated anti-nociceptive effects in several painful conditions. We investigated whether β-blockers are associated with a reduced risk of total joint replacement (TJR) at the knee or the hip in people with incident knee or hip OA.

Methods:
This was a cohort study. We used data from the Clinical Practice Research Datalink. Participants aged 40 years or older with incident knee or hip OA, prescribed β-blockers following OA diagnosis (new-user design) and their age, sex, OA location and propensity score (PS) for β-blocker prescription matched controls were included in the study. 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-MP v15.

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 with membrane stabilising effect 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).

Conclusions:
The non-selective β-blocker propranolol reduces the risk of knee or hip TJR, consistent with its analgesic effects demonstrated in other conditions. A randomised controlled trial is required to further evaluate the analgesic potential of propranolol in OA.

Citation

Nakafero, G., Grainge, M. J., Valdes, A. M., Townsend, N. P., Mallen, C., Zhang, W., Doherty, M., Mamas, M. A., & Abhishek, A. 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. https://doi.org/10.3310/nihropenres.13462.1. Manuscript submitted for publication

• Journal Article Type: Other
• Deposit Date: Jul 8, 2025
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.3310/nihropenres.13462.1
• Public URL: https://keele-repository.worktribe.com/output/1319364