Beta-blockers may reduce the need for total knee arthroplasty (TKA) in people with osteoarthritis, a Spanish case-control study reports.

Researchers analysed 300 people with new-onset knee pain who underwent TKA and the same number of matched controls who did not have knee replacements. Seventy-one per cent of patients in each group were female. The average age was about 68 years.

Compared with non-users, any use of beta-blockers during follow-up (mean 2.2 and 2.1 years respectively) reduced TKA risk by 49 per cent. Non-selective beta-blockers reduced TKA risk by 58 per cent, while selective beta-blockers reduced TKA risk by 31 per cent, although this was not statistically significant. 

Any recent use (previous two years) of beta-blockers reduced TKA risk by 35 per cent. A proportion of days covered (PDC; a measure of adherence) of less than 25 per cent during the previous two years reduced TKA risk by 38 per cent. The risk reductions were 68 and 45 per cent for 25-75 per cent and 75 per cent and more PDC respectively. Using beta-blockers for less than a year, one to five years, and five years and longer reduced TKA risk by 59, 48 and 64 per cent respectively.

Beta-blockers may reduce pain and inhibit OA degeneration by downregulating several inflammatory mediators that destroy cartilage. However, the follow-up was relatively short and the sample sizes relatively small so randomised controlled trials or prospective observational studies are needed to confirm the findings. (J Bone Joint Surg Am 2023; DOI: 10.2106/JBJS.22.01189)