New Study: Don’t Wait on that Joint Replacement!

Physicians often suggest to their patients with knee and hip problems that they delay resorting to artificial joints for as long as possible, according to a report in the Boston Globe. Their doctors urge them to try less invasive treatments first—in part because surgery brings its own risks and the process of rehabilitation after surgery can be arduous.

That physician suggestion may be a mistake. A recent study of the outcomes of joint replacement surgery for 17, 000 patients found that patients who wait until they are severely incapacitated do not benefit as much from their joint replacement as do those who had their surgery earlier.

Although the reasons for this are not yet clear, the researchers suspect it is because the patients were disabled for such a protracted length of time that the muscles around their joints severely deteriorated, as did their heart and lung capacity. With more and more Americans replacing worn-out hips and knees, researchers are working to quantify the effects of treatments and surgeries by building databases that track patients over the long term.

“We can actually measure where patients were before the surgery, how limited they were, how much pain they had, and we can look a year after surgery, ” said. David Ayers M.D., who heads the department of Orthopedics and Physical Rehabilitation at University of Massachusetts Medical School, and is a lead researcher on the federally-funded project called FORCE-TJR.

The FORCE researchers are creating a registry that collects detailed information from patients before and after hip or knee surgery. They ask patients about their overall health, pain levels, and ability to perform very specific tasks, such as climbing stairs or getting in and out of a car. It tracks problems with implants and surgeries.

To date, with their patients’ consent, more than 130 orthopedic surgeons across 23 states are contributing patient information. The goal is to include at least 30, 000 patients that researchers will track for years. They have already enrolled 20, 000 patients, Ayers told the Boston Globe reporter.

A national scoring system pegs people without joint problems at a “level 50.” Ayerss team discovered that the typical patient in its database had deteriorated to a level 32 before opting to undergo surgery for an artificial joint. These patients had severe limitations but were not entirely hobbled by worn out joints.

Ayers and his colleagues found that their typical patient experienced a 12-point improvement after surgery, bringing them near the function of patients who did not have deteriorated joints. But they also discovered that patients who waited until their ability to function was scored at 25 or lower—who were severely disabled—generally did not get the full 12-point improvement from surgery. Roughly 40% of these patients only improved to a level that most patients were at just before they had surgery.

With more and more patients under age 65 opting for joint replacement surgery it has become important to find out if today’s’ devices will reliably last for 20 years or more. William Maloney M.D., who chairs the registry’s board of directors and orthopedic surgery at Stanford University Medical Center, started planning the joint replacement registry in 2000 when implant failure was happening frequently. “That’s the advantage of a registry, ” Maloney said. “We will have that data.”