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Early joint replacement may be
better for hip and knee osteoarthritis
What problem was studied?
Osteoarthritis (OA) commonly affects the hips and knees and can result in
debilitating pain, loss of mobility and eventually severe disability. Total
joint replacement surgery often provides dramatic improvement in quality of
life. Such surgery is often delayed as long as possible because of the expense
and concerns about the longevity of implants and the potential need for revision
surgery. No previous studies have looked at the effects of delaying hip and knee
surgery on long-term surgical outcomes.
Arthritis Foundation-funded researcher involved in the study: Jeffrey N. Katz, MD, MSc, Brigham and Women’s
Hospital, Harvard University, Boston, supported by an AF clinical grant
What was done in the
study?
This study followed 222 patients with OA who were undergoing total hip
or knee replacement surgery at teaching hospitals in Boston and Montreal. The
patients’ pain and physical function were assessed prior to surgery and then
3, 6 and 24 months after surgery. Prior to surgery, patients were divided into
two groups, a high and low function group according to their level of physical
function.
What were the study
results?
 Complete two-year data was collected from 165 patients. While all of the
patients showed improvement at six months, those in the low function group at
the time of surgery had much worse pain and function than those in the high
function group. People who delayed their joint replacement surgery until they
had severe functional decline had the worst outcomes. These differences
persisted through the two-year follow-up period. Furthermore at two years, 5
times as many persons in the low function group required assistance from another
person with daily tasks such as bathing and dressing.
What’s the relevance to
people with arthritis?
In this study, the long-term outcome following total joint replacement was worse
in those who had severe pain and disability at the time of surgery. The study
results support the argument for operating earlier in the disease course. Adds
lead author, Dr. Jeff Katz, "Total joint replacement has traditionally been
presented to patients as a last resort, when the pain is unbearable. Our study
supports a growing trend to challenge this notion. Our data suggest that
clinicians should present the advantages of earlier vs. later surgery to
patients with advanced arthritis, and permit patient preferences to dictate when
surgery is performed."
Source:
Arthritis and Rheumatism, December
2002
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12483739&dopt=Abstract
 
Research Update is compiled by
Michele Boutaugh, BSN, MPH, Medical and Scientific Affairs Department,
National Office.
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