Elderly Patients With Osteoarthritis May Benefit From Joint Replacement Surgery
July 15, 2008 — In elderly patients with osteoarthritis (OA), joint replacement surgery is effective and alleviates osteoarthritic symptoms, according to the results of a prospective cohort study reported in the July 14 issue of the Archives of Internal Medicine.
"OA of the hip and knee is a common cause of pain and disability in elderly patients," write Mary Beth Hamel, MD, MPH, from... Beth Israel Deaconess Medical Center in Boston, Massachusetts, and colleagues. "Joint replacement surgery can alleviate pain and restore function but is associated with risks and discomfort."
The investigators evaluated decision making and clinical outcomes in 174 patients 65 years and older with severe OA of the hip or knee in whom conservative treatments did not adequately control symptoms. OA symptoms and functional status were measured at baseline and at 12 months, and postoperative symptoms and function were evaluated at 6 weeks, 6 months, and 12 months after surgery.
Mean age of the patients was 75 years; 76% were women, 17% were nonwhite, 69% had knee OA, and 31% had hip OA. Mean Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score was 56 on a 100-point scale.
During a 12-month follow-up, 29% had joint replacement surgery. Among these patients, none died, 17% had postoperative complications, and 38% had postoperative pain lasting longer than 4 weeks. Median time to regaining walking independently was 12 days, and median time to doing household chores was 49 days. Recovery times were similar for patients 65 to 74 years old and those 75 years or older.
At 12 months, WOMAC scores improved by 24 points in surgical patients vs 0.5 point in patients who did not undergo surgery (P < .001). In patients 75 years or older, improvements were 19 points and 0.3 points, respectively (P < .001). Among patients not treated surgically, 45% reported that surgery was not offered as a potential treatment option.
"Elderly patients who had hip or knee replacements for severe OA took several weeks to recover but experienced excellent long-term outcomes," the study authors write. "Physicians often do not discuss joint replacement surgery with elderly patients who might benefit."
Limitations of this study include selection of patients for surgery; lack of randomization; possible unmeasured confounders; insufficient size to exclude modest differences in the 2 age groups; and participation in the study involved interviews about OA symptoms and decision making about joint replacement surgery, which may have led to patients having more discussion with their clinicians about these issues.
"Improved communication between physicians and patients aged may allow more elderly patients to make informed choices and to thoughtfully weigh the risks and burdens of joint replacement surgery against its benefits in alleviating pain and improving function and quality of life," the study authors conclude.
The Paul Beeson Physician Faculty Scholars in Aging Research Program supported this study. Dr. Hamel has obtained funding. The other study authors have disclosed no relevant financial relationships.
Arch Intern Med. 2008;168:1430-1440.
"OA of the hip and knee is a common cause of pain and disability in elderly patients," write Mary Beth Hamel, MD, MPH, from... Beth Israel Deaconess Medical Center in Boston, Massachusetts, and colleagues. "Joint replacement surgery can alleviate pain and restore function but is associated with risks and discomfort."
The investigators evaluated decision making and clinical outcomes in 174 patients 65 years and older with severe OA of the hip or knee in whom conservative treatments did not adequately control symptoms. OA symptoms and functional status were measured at baseline and at 12 months, and postoperative symptoms and function were evaluated at 6 weeks, 6 months, and 12 months after surgery.
Mean age of the patients was 75 years; 76% were women, 17% were nonwhite, 69% had knee OA, and 31% had hip OA. Mean Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score was 56 on a 100-point scale.
During a 12-month follow-up, 29% had joint replacement surgery. Among these patients, none died, 17% had postoperative complications, and 38% had postoperative pain lasting longer than 4 weeks. Median time to regaining walking independently was 12 days, and median time to doing household chores was 49 days. Recovery times were similar for patients 65 to 74 years old and those 75 years or older.
At 12 months, WOMAC scores improved by 24 points in surgical patients vs 0.5 point in patients who did not undergo surgery (P < .001). In patients 75 years or older, improvements were 19 points and 0.3 points, respectively (P < .001). Among patients not treated surgically, 45% reported that surgery was not offered as a potential treatment option.
"Elderly patients who had hip or knee replacements for severe OA took several weeks to recover but experienced excellent long-term outcomes," the study authors write. "Physicians often do not discuss joint replacement surgery with elderly patients who might benefit."
Limitations of this study include selection of patients for surgery; lack of randomization; possible unmeasured confounders; insufficient size to exclude modest differences in the 2 age groups; and participation in the study involved interviews about OA symptoms and decision making about joint replacement surgery, which may have led to patients having more discussion with their clinicians about these issues.
"Improved communication between physicians and patients aged may allow more elderly patients to make informed choices and to thoughtfully weigh the risks and burdens of joint replacement surgery against its benefits in alleviating pain and improving function and quality of life," the study authors conclude.
The Paul Beeson Physician Faculty Scholars in Aging Research Program supported this study. Dr. Hamel has obtained funding. The other study authors have disclosed no relevant financial relationships.
Arch Intern Med. 2008;168:1430-1440.