The long term health outcomes of hip or knee replacement surgery in older adults are excellent despite taking several weeks to recover, according to a report released on July 14, 2008 in the Archives of Internal Medicine, one of the JAMA/Archives journals.
Osteoarthritis is a degenerative joint disease characterized by inflammation caused by damage to the cartilage that cushions them. It causes debilitating pain and can seriously restrict mobility and physical ability. While there are several non-invasive treatments, including medications and physical therapy, these seem to be of limited value for advanced stage osteoarthritis. Surgery is an option, but has previously been associated with risks and discomfort. Osteoarthritis often occurs in older people, and as the population of the United States ages, the number of older adults with this disease is increasing.
In order to investigate the risks and potential benefits of surgical interventions, Mary Beth Hamel, M.D., M.P.H., and colleagues at Beth Israel Deaconess Medical Center, Boston, examined the decisions and treatment outcomes in patients over the age of 65 with severe osteoarthritis. A total 174 patients were tracked, with an average age of 75.2 years, and monitored for arthritis symptoms, functional status between 2001 and 2004 with follow-up after 12 months. Additionally, any patients who chose to have joint replacement surgery were assessed six weeks, six months, and 12 months later.
In the 12 months of follow-up, 29% (51 patients) of the total group underwent joint replacement surgery. This was composed of 30 knee and 21 hip replacements. Of these, none patients died, 17% had postoperative complications, and 38% had pain that lasted more than four weeks after the surgery. In a comparison of age, patients 75 and older took approximately the same amount of time to return to regular activities as patients between 65 and 74. Most patients required assistance with activities like household chores and shopping for more than one month after surgery.
In the measurement of osteoarthritis symptoms, at the 12 month mark, scores improved more significantly in patients who underwent surgery than those who did not. Approximately half of patients who did not have surgery reported that this option was not offered to them. In comparison with the post-surgical patients, participants who did not have surgery were generally older, with lower incomes, and more worried about surgical complications and a long recovery time.
The authors conclude that joint replacement surgery could be a useful option for osteoarthritis sufferers. “Our findings of excellent outcomes from joint replacement surgery in elderly patients with severe hip or knee osteoarthritis corroborate and extend the findings of previous studies,” they say. “These data should help inform discussion about joint replacement surgery and allow patients to consider the risks and benefits of surgery as well as the expected postoperative recovery experience.”
Joint Replacement Surgery in Elderly Patients With Severe Osteoarthritis of the Hip or Knee
Decision Making, Postoperative Recovery, and Clinical Outcomes
Mary Beth Hamel, MD, MPH; Maria Toth, MD, PhD; Anna Legedza, ScD; Max P. Rosen, MD, MPH
Arch Intern Med. 2008;168(13):1430-1440.
Written by Anna Sophia McKenney