Replacing joints early may be better than waiting for some osteoarthritis sufferers

Friday, December 13, 2002

In a paper published in the December 5th edition of the journal Arthritis and Rheumatism, researchers at Brigham and Women's Hospital (BWH), and the Toronto Western Hospital, concluded that people who suffer from osteoarthritis may not want to wait until their pain is unbearable to replace their knees or hips.

The study's authors followed the progress of patients who opted to have joint replacement surgery. They found that those patients who had postponed having the surgery the longest -- and therefore were experiencing the most pain and loss of joint function -- also experienced the worst results two years after joint replacement surgery.

"Many patients and doctors have traditionally regarded this kind of surgery as a last-resort sort of procedure," said the study's senior author, Jeffrey Katz, MD, of BWH. "But we found that patients could have a positive impact on their quality of life by being proactive about the real benefits associated with having this surgery before their conditions completely degenerate."

In the study, 222 patients were divided into two groups: those with higher joint function and less pain, and those with more pain, and less joint function. These patients were then tested three, six, and 24 months after their surgeries to determine if their conditions had improved.

Researchers noticed very little difference between how people felt after six months, compared to how they felt after two years. However, the patients who went into surgery feeling the worst, also felt worse than the healthier group two years after having their hips or knees replaced.

According to the Arthritis Foundation, osteoarthritis affects an estimated 20.7 million Americans, usually after age 45. The disease breaks down the joint's cartilage. Cartilage is the cushion in the joint found at the end of bones. Bones begin to rub together once the cartilage begins to deteriorate, causing pain and impaired mobility.

Given that joint replacement surgery is now safer, and that prosthesises are made to now last longer, researchers believe that joint replacement surgery should be considered in terms of the potential improvement it may have in a person's quality of life. Replaced knees generally last anywhere from 15 to 20 years, and hips for 10 to 20 years, said Katz.

"There are many things that are worth waiting for, but having your joint's replaced may not be one of them," Katz added. "This is a procedure that a patient should choose to do, rather than one for which a patient must resort."

BWH is a 716-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare System, an integrated health care delivery network. Internationally recognized as a leading academic health care institution, BWH is committed to excellence in patient care, medical research, and the training and education of health care professionals. The hospital’s preeminence in all aspects of clinical care is coupled with its strength in medical research. A leading recipient of research grants from the National Institutes of Health, BWH conducts internationally acclaimed clinical, basic and epidemiological studies.

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