Outcomes Excellent for Joint Replacement in Older Adults
By Judith Groch
BOSTON, 15 july 2008 -- Elderly patients who had hip or knee replacement for severe osteoarthritis took several weeks to recover but had excellent long-term outcomes, a prospective study found.
Yet, of those who did not have surgery, 45% reported that surgery was not offered as a potential treatment, Mary Beth Hamel, M.D., of Beth Israel Deaconess Medical Center, and colleagues reported in the July 14 issue of the Archives of Internal Medicine.
As the U.S. population ages, joint replacement surgery among Medicare recipients has become more common. Medication and physical therapy appear to be of limited value for the advanced stages of osteoarthritis, the authors wrote, although surgery may be associated with risks and discomfort.
To help physicians and patients determine treatment, the researchers conducted a prospective cohort study to examine decision making and clinical outcomes for patients 65 or older with severe, inadequately controlled osteoarthritis of the hip or knee.
The study included 174 patients (mean age 75.2, 76% female, and 17% nonwhite) screened at Beth Israel's radiology facility from August 2001 to July 2004.
Of the total group, 69% had osteoarthritis of the knee and 31% had hip disease. The mean Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score was 56 on a 100-point scale.
During a 12-month follow-up period, 51 (29%) had joint replacement surgery including 30 knee and 21 hip replacements.
None of the patients died, but seven (17%) had postoperative complications, such as delirium, pulmonary embolism or edema, deep wound infection, or anemia.
The complication rate was 16% for patients 60 to 74 and 18.8% for those 75 and older (P> 0.99).
All patients reported post-op pain with 38.3% reporting pain lasting more than four weeks.
Of 47 surgery patients who responded to survey questions, most required assistance with activities such as shopping and household chores for more than a month.
The median time to independence in walking was 12 days and for handling household chores, 49 days. These times were similar for patients 65 to 74 and those 75 years or older.
Time to return to other activities of daily living varied, averaging seven days to go to the bathroom, 14 days to dress, 21 days for independence in bathing and for food preparation, and 60 days for shopping.
After six months, only about 30% were able to independently manage outside activities such as gardening.
At 12 months, WOMAC scores improved by 24 points among patients who had surgery and 0.5 points among those who did not (P<0.001). href="http://archinte.ama-assn.org/cgi/content/short/168/13/1430"> Arch Intern Med 2008; 168: 1430-1440.
Yet, of those who did not have surgery, 45% reported that surgery was not offered as a potential treatment, Mary Beth Hamel, M.D., of Beth Israel Deaconess Medical Center, and colleagues reported in the July 14 issue of the Archives of Internal Medicine.
As the U.S. population ages, joint replacement surgery among Medicare recipients has become more common. Medication and physical therapy appear to be of limited value for the advanced stages of osteoarthritis, the authors wrote, although surgery may be associated with risks and discomfort.
To help physicians and patients determine treatment, the researchers conducted a prospective cohort study to examine decision making and clinical outcomes for patients 65 or older with severe, inadequately controlled osteoarthritis of the hip or knee.
The study included 174 patients (mean age 75.2, 76% female, and 17% nonwhite) screened at Beth Israel's radiology facility from August 2001 to July 2004.
Of the total group, 69% had osteoarthritis of the knee and 31% had hip disease. The mean Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score was 56 on a 100-point scale.
During a 12-month follow-up period, 51 (29%) had joint replacement surgery including 30 knee and 21 hip replacements.
None of the patients died, but seven (17%) had postoperative complications, such as delirium, pulmonary embolism or edema, deep wound infection, or anemia.
The complication rate was 16% for patients 60 to 74 and 18.8% for those 75 and older (P> 0.99).
All patients reported post-op pain with 38.3% reporting pain lasting more than four weeks.
Of 47 surgery patients who responded to survey questions, most required assistance with activities such as shopping and household chores for more than a month.
The median time to independence in walking was 12 days and for handling household chores, 49 days. These times were similar for patients 65 to 74 and those 75 years or older.
Time to return to other activities of daily living varied, averaging seven days to go to the bathroom, 14 days to dress, 21 days for independence in bathing and for food preparation, and 60 days for shopping.
After six months, only about 30% were able to independently manage outside activities such as gardening.
At 12 months, WOMAC scores improved by 24 points among patients who had surgery and 0.5 points among those who did not (P<0.001). href="http://archinte.ama-assn.org/cgi/content/short/168/13/1430"> Arch Intern Med 2008; 168: 1430-1440.
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