Patients with heart failure can safely undergo hip or knee replacement surgery and experience similar improvement in joint pain and function as patients without heart failure, indicate two Cleveland Clinic studies.
“With thoughtful optimization and care coordination, we can help the growing population of people with comorbid osteoarthritis and heart disease regain mobility and independence,” says senior author nicolas S. Piuzzi, MD, Enterprise Vice chair of Research for Orthopaedics and Rehabilitation at Cleveland Clinic.
due to advancements in the treatment of both heart failure and joint pain in recent decades, it’s vital to understand care pathways for patients with both conditions, he says. Joint problems can directly affect a patient’s ability to perform exercise as part of cardiac rehabilitation.”We all want our patients to have the best quality of life,” says study coauthor Paulino Alvarez, MD, a heart failure specialist at Cleveland Clinic. “Sometimes I see patients with heart failure who have been suffering with joint pain that limits their quality of life. Many centers refuse joint replacement surgery for these patients because of their history of heart failure and risk of complications. At the same time, these patients are contraindicated for NSAIDs, a mainstay in treating osteoarthritis pain. These patients need an altern
Patient Reported Outcome Measures (PROMs) Following Joint Replacement Surgery
Table of Contents
Here’s a summary of patient-reported outcome measures following joint replacement surgery, broken down by heart failure status. Scores represent median values.
Overall Satisfaction & Functional Improvement
| Outcome Measure | Patients with Heart Failure | Patients without Heart Failure |
|---|---|---|
| Oxford Shoulder Score | 75.1 | 75.1 |
| Oxford Hip score | 76.3 | 76.3 |
| Overall joint replacement | 76.3 | 76.3 |
Pain Levels
| Outcome Measure | Patients with Heart Failure | Patients without Heart Failure |
|---|---|---|
| Pain (Median Score) | 88.9 | 86.1 |
Median score indicates the middle value in a range of responses, providing a typical score for patients in each group.
These findings in knee arthroplasty were echoed in a separate but similar study of hip arthroplasty.Out of nearly 11,000 patients who had total hip replacement (THR) at Cleveland Clinic between 2016 and 2021, nearly 400 had heart failure (J Arthroplasty. 2025 Aug 6:S0883-5403(25)00977-5).
after THR,patients with heart failure had a higher risk of:
* Hospital stay of three days or longer (OR 2.12, P < .001)
* Nonhome discharge (OR 1.61,P =.003)
* Mortality within one year (OR 3.40, P = .008)
The slight rise in one-year mortality aligns with the expected course of heart failure and is not considered a cause for concern relative to surgical safety or benefit, notes Dr. Piuzzi.
one year after surgery, patients with heart failure achieved pain and function improvements comparable to those without heart failure.
Hip Disability and osteoarthritis Outcome Scores, 1 Year After THR
| Pain | 92.5 | 95.0 |
Heart Failure Doesn’t hinder Joint Replacement Success
Here’s a look at median hip and knee health scores following joint replacement, broken down by heart failure status:
Knee Replacement
| Patients with heart failure (median score) | Patients without heart failure (median score) | |
|---|---|---|
| Patients with heart failure (median score) | 91.2 | |
| Patients without heart failure (median score) | 95.4 |
Overall Joint Replacement
| Patients with heart failure (median score) | Patients without heart failure (median score) | |
|---|---|---|
| Patients with heart failure (median score) | 85.3 | |
| Patients without heart failure (median score) | 85.3 |
On a scale of 0-100, where 100 is best hip health
“We were not surprised to see that patients with heart failure in both cohorts had higher healthcare utilization and higher mortality rates. That was expected,” Dr. Piuzzi says. “However, most patients with heart failure ultimately walked away from knee and hip replacement with excellent improvement in pain and function, comparable to patients without heart failure.”
Joint Replacement: A vital Component of Overall Health, Especially for Heart Failure Patients
Joint replacement surgery isn’t simply about improving quality of life; it can be a crucial step in maintaining overall health and enabling physical activity, especially for individuals with conditions like heart failure. As healthcare professionals increasingly recognize, functional mobility – the ability to perform everyday tasks like walking, bathing, and even cardiac rehabilitation – is deeply connected to broader health outcomes.
The Broader Impact of Joint Function
Traditionally, joint replacement has been viewed as an elective procedure focused on alleviating pain and improving mobility. however, experts emphasize the far-reaching implications of a functional, pain-free joint.
“patients with complex conditions sometimes need a higher level of care,” explains an orthopedic surgeon. “Despite that, they still can have excellent outcomes. Joint replacement should not be viewed as a luxury or merely an improvement in quality of life. Having a functional, pain-free joint has broad implications, including being able to independently get out of bed, go to the bathroom, go to the store – performing basic human tasks, even cardiac rehabilitation.”
This highlights a shift in viewpoint: joint health is integral to a patient’s ability to participate in activities that support overall well-being.
Joint Health and Heart Failure: A Critical Connection
The link between joint health and cardiovascular health is particularly strong.Regular physical activity is a cornerstone of managing and improving heart failure,but pain and limited mobility can make exercise arduous or impossible.
Amanda Vest, MBBS, Section Head of Heart Failure and Recovery at Cleveland clinic, underscores this connection: “Optimizing joint health is a particularly critically important consideration for our patients with heart failure as we certainly know that regular physical activity is highly beneficial for people living with this cardiac condition. A knee or hip replacement can be a key step in enabling patients to keep active and improve their cardiovascular fitness.” https://my.clevelandclinic.org/staff/32674-amanda-vest
This means that addressing joint pain through procedures like knee or hip replacement can directly contribute to a patient’s ability to engage in cardiac rehabilitation and maintain a healthier heart. The American Heart Association emphasizes the importance of regular physical activity for heart health, recommending at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic activity per week. https://www.heart.org/en/healthy-living/fitness/fitness-basics/aha-recommends
Key Takeaways
* joint replacement is more than just pain relief: It’s a vital component of overall health and functional independence.
* Mobility impacts quality of life: Being able to perform basic daily tasks is essential for well-being.
* Joint health is crucial for heart failure patients: It enables participation in vital cardiac rehabilitation and regular exercise.
* Proactive intervention is key: Addressing joint pain can improve cardiovascular fitness and overall health outcomes.
looking Ahead
As the population ages and the prevalence of both arthritis and heart failure increases, the importance of recognizing the interconnectedness of these conditions will only grow. A holistic approach to patient care – one that considers joint health as a critical factor in overall well-being – will be essential for optimizing outcomes and improving the lives of individuals facing these challenges. Further research into the synergistic benefits of joint replacement and cardiac rehabilitation is also needed to refine treatment protocols and maximize patient benefits.