A study of 602, 733 osteoarthritis patients enrolled in the U.K.’s Health Improvement Network from 2000 to 2012 died at a 28% lower rate than non-knee replacement (KR) recipients.
Do Joint Replacement Patients Live Longer? Maybe
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The protective effect on mortality emerged only in those patients older than 63, according to contributing writer Diana Swift in MedPage Today which first released the study.
Devyani Misra, M.D., MSc, of Boston University School of Medicine, commented to Swift that the mortality benefit effect seen in older patients may be subject to confounding by selection in which good candidates have the procedure and more ill candidates do not. “If you have two 80-year-old patients, one frail and one robust, you would select the robust patient to undergo surgery, ” she said. “I won’t be telling my OA [osteoarthritis] patients that if you have knee replacement, you’ll live longer.”
The study was a rigorous one. The researchers identified 14, 042 pairs of participants diagnosed with knee OA who either had or did not have a knee replacement. They carefully matched the participants with propensity scores for multiple variables in order to ensure maximum comparability. Their mean age of the subjects was about 71. Fifty-seven percent were female and their mean body mass index was 29.2. The mean follow-up time was 4.42 years for the knee replacement patients and 4.31 years for their non-knee-replacement counterparts.
During follow-up, according to MedPage Today, there were 1, 159 deaths in the KR group and 1, 418 in the non-KR group. In quartile 1, the youngest age group (
Because knee replacement can improve pain relief, function, and activity, the general impression has been that enhanced mobility may lead to a decreased risk of long-term mortality. Misra pointed out, however, that studies evaluating long-term mortality risk with KR have reported conflicting results. For example, a large study using data from the Swedish Knee Arthroplasty Registry found a lower mortality rate with KR, while a German study identified no KR-related difference in mortality risk when it was compared with the general population.
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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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