Hormone replacement can prevent secondary knee and hip replacement surgeries

Category: Blog

Many times we will see patients following a hip replacement surgery or a knee replacement surgery who have continued pain. Pain after joint replacement has been well documented in the medical research.

In this article we are going to concentrate on a main problem – joint replacement loosening and new research that ties in hormone replacement therapy.

Examining the link between hormones and joint pain is something we obviously look at on a daily basis. We recently reported on research from Oxford University that showed hormone replacement therapy taken regularly for six months after a knee or hip replacement seemed to cut the risk of repeat surgery by around 40%.1

Osteolysis (bone weakening or bone loss following joint replacement) and subsequent prosthesis loosening is the most common cause for revision following total knee arthroplasty (replacement) or total hip arthroplasty (replacement). Hormone replacement therapy (HRT) can reduce the risk of osteolysis problems.

Doctors at the University of Gothenburg, Sweden confirmed a terrible connection: “systemic inflammation present in rheumatoid arthritis, decreased estradiol levels in postmenopausal rheumatoid arthritis patients, further accelerating bone loss in these patients.”Rheumatoid arthritis more commonly involves inflammation and swelling of the joints rather than a wearing away of the cartilage as in osteoarthritis.

More recently doctors at the Mayo Clinic looked at the problem of 7 million people walking around with hip or knee replacements and the fact that the majority of these individuals will outlive their implants and require revision surgeries, mostly due to poor implant osseointegration (the bone and the implant did not fuses as well as hoped for) and aseptic loosening.

Revisions are potentially avoidable with better management of patient-related risk factors that affect the osseointegration of orthopedic implants. In their study the Mayo doctors focused on several systemic and local factors that are particularly relevant to implant osseointegration. Examples include problems of hyperglycemia, oxidative stress, metabolic syndrome and high cholesterol. In addition the other factors can prevent the bone from achieving osseointegration with the implant. This includes hormone replacement therapy and selective estrogen-receptor modulators.3 Here again hormone replacement therapy address the problems of failing joint replacement.3

Bio-identical hormones

At the Magaziner Center for Wellness, we use bio-identical hormones (BHRT). Bio-identical hormones are different than synthetic hormones because they are structurally and chemically the same as the three estrogens naturally produced by the body – Estriol, Estradiol and Estrone and natural progesterone, testosterone and others, depending on the needs of the patient. Synthetic hormones – namely conjugated estrogens feature a manipulated form of the three estrogens while Medroxyprogesterone Acetate (MPA), which is found in Provera, is a synthetic form of progesterone. To learn more about our Bio-Identical Hormone program please visit this page on our site Bio-Identical Hormone Replacement.

1 . D. Prieto-Alhambra, M. K. Javaid, A. Judge, J. Maskell, C. Cooper, N. K. Arden, M. Mullee, J. Rafferty, A. Carr, A. Price, K. Javaid, D. Beard, D. Altman, N. Clarke. Hormone replacement therapy and mid-term implant survival following knee or hip arthroplasty for osteoarthritis: a population-based cohort study. Annals of the Rheumatic Diseases, 2014; DOI: 10.1136/annrheumdis-2013-204043

2 Andersson A, Bernardi AI, Nurkkala-Karlsson M, Stubelius A, Grahnemo L, Ohlsson C, Carlsten H, Islander U.  Suppression of Experimental Arthritis and Associated Bone Loss by a Tissue-Selective Estrogen Complex. Endocrinology. 2016 Mar;157(3):1013-20. doi: 10.1210/en.2015-1820. Epub 2016 Jan 8.

3 Kremers HM, Lewallen EA, van Wijnen AJ, Lewallen DG. Clinical Factors, Disease Parameters, and Molecular Therapies Affecting Osseointegration of Orthopedic Implants. Current Molecular Biology Reports. 2016 Sep 1;2(3):123-32.