If the team led by Gillian Hawker, M.D., of the University of Toronto, is correct only about half of the people who have a knee or hip replaced see meaningful improvements in pain and disability in the months after surgery. The group tracked 2, 400 older adults with osteoarthritis or inflammatory arthritis in Ontario, Canada, and followed those had surgery to see how they fared.
Pain Slow to Retreat After Replacement
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The study started in 1996 and continued through 2011. A total of 479 of the subjects had a knee or hip replaced, including 202 who underwent elective surgery and had before and after pain and disability information available for analysis. Most of the surgery patients were women who experienced pain in more than one joint. More than 80% of the subjects were overweight or obese.
The researchers found that those individuals who had the greater knee or hip pain to begin with, fewer general health problems overall and no arthritis outside of the replaced joints were the ones who were more likely to report benefits. The research team wrote in the journal Arthritis and Rheumatism that by one to two years after surgery, the average person had a 10-point improvement in pain and disability from a pre-surgery score of 46.5 out of 100. According to the report in the Canadian publication Independent, i.e., a nine-point improvement is considered the “minimal important difference” in symptoms, and about 54% of joint-replacement patients hit that target.
“I think this study really represents the general picture that often people do not have arthritis in just one joint, ” said Elena Losina, an orthopedic and arthritis researcher from Brigham and Women’s Hospital in Boston. “It’s good to set expectations appropriately so that if you have three joints affected, doing one procedure is not going to be a miracle.” Losina, who co-wrote a commentary published with the new study, said that even if a first joint replacement leaves people with some pain and disability, it may help them make incremental steps toward better health. And doctors may need to realize that until some people get each of their painful joints replaced—not just one knee or hip—they’re not going to have optimal outcomes.
More than one million people in the U.S. have a knee or hip replaced each year, researchers said—a rate that’s expected to continue to grow.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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