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News Americas

A knee replacement owing to arthritis does not necessarily mean that patients are pain free postoperatively. (Photo: GerardM)
Apr 22, 2013 | News Americas

Hip and knee replacement: Not all patients benefit from surgery

by Surgical Tribune

TORONTO, Canada: Only half of people with arthritis who have had a hip or knee replacement report a significant improvement in pain and mobility after surgery, a study has found. The authors state that, while the demand for joint replacement surgery has increased as the population ages, physicians lack a set of established criteria to help determine which patients will benefit from surgery.

The study was led by Women's College Hospital and the Institute for Clinical and Evaluative Sciences (ICES). "Many patients with hip or knee arthritis have the condition in more than one of their hip or knee joints," said the study's lead author Dr. Gillian Hawker, physician-in-chief at Women's College Hospital and a senior scientist at ICES. "So it's not surprising that replacing a single joint doesn't alleviate all their pain and disability — patients may need subsequent surgeries to maximize the benefits of joint replacement."

The study followed a cohort of 2,400 patients with osteoarthritis and inflammatory arthritis in Ontario. It drew its participants from a cohort of 2,400 patients with osteoarthritis and inflammatory arthritis in Ontario. Nearly 480 of these patients had had a hip or knee replacement and 202 were included in the study. Of these, only half reported a meaningful improvement in their overall hip and knee pain and disability one to two years after surgery . Furthermore, researchers found the patients who had worse knee or hip pain to begin with but fewer general health problems and no arthritis outside of the replaced joint were more likely to report benefits.

According to the study authors, nearly 83 percent of the study participants had at least two troublesome hips and/or knees. In general, an estimated 25 percent of patients who undergo a single joint replacement will have another joint replacement — usually the other hip or knee — within two years.

"While demand for joint replacement surgery has increased as our population ages, physicians lack a set of established criteria to help determine what patients will benefit from surgery and at what point during the course of the disease," said Hawker. "As physicians, we need to do a better job of targeting treatments to the right patient at the right time by the right provider."

Arthritis is a leading cause of disability in men and women in Canada. According to the Arthritis Society, joint damage from osteoarthritis is responsible for more than 80 percent and 90 percent of hip and knee replacement surgeries in Canada, respectively.

The study, titled "Which Patients are Most Likely to Benefit From Total Joint Arthroplasty?" was published online ahead of print in the Arthritis and Rheumatism journal.

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