Timing of total joint replacement affects clinical outcomes among patients with osteoarthritis of the hip or knee

Abstract

Objective. To determine the predictors of outcome in patients with osteoarthritis 2 years after receiving total hip or knee replacement.Methods. A prospective cohort study of 222 osteoarthritis patients undergoing total hip or knee replacement in Boston and Montreal was done. Their postoperative outcomes at 6 months were previously reported. This followup reports on the outcomes after 2 years among the 165 patients (74%) who remained. The subjects were divided into 2 groups according to the median value of their preoperative Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function score. The Short Form 36-item physical function subscale and the WOMAC pain and function subscale scores were collected at baseline and at 3, 6, and 24 months postoperatively. Clinical outcomes were analyzed at 2 years, using descriptive and multiple regression analyses.Results. Improvements in pain and function at 2 years were similar to those observed at 6 months. Those subjects with the worst function and pain at the time of surgery (baseline) had comparatively worse function 2 years after surgery.Conclusion. In this comparison, the poor outcomes observed at 6 months following total joint replacement in patients with worse baseline functional status persisted after 2 years. Although there are no validated indications for when a patient should optimally have total joint replacement, these data suggest that timing of surgery may be more important than previously realized and, specifically, that performing surgery earlier in the course of functional decline may be associated with better outcome.Total hip replacement (THR) and total knee replacement (TKR) are both highly successful and costeffective procedures for end-stage joint disease. The influence of the timing of these two procedures on patient outcomes has not been studied formally. In a natural experiment, 2 cohorts of patients treated in academic health centers in Boston and Montreal were studied. Although all patients showed improvement at 6 months postoperatively, those with the worst function and pain at the time of surgery (baseline) had comparatively poorer function at followup (1). In this study, we examined whether these results persisted up to 2 years after surgery, when the majority of patients have achieved optimal postoperative results. PATIENTS AND METHODSPopulation. We performed a prospective cohort study of 222 consecutive persons undergoing elective THR and TKR for osteoarthritis at a Boston and a Montreal teaching hospital. At 2 years postoperatively, followup information was available on 165 patients.

Severely compromised quality of life in women and those of lower socioeconomic status waiting for joint replacement surgery

“…Documentation of the status of patients on waiting lists is an important clinical issue because previous research has shown that high preoperative pain and poor physical function predict poor surgical outcomes up to 2 years following total hip or knee replacement (5,9).…”

Factors and Consequences of Waiting Times for Total Hip Arthroplasty

“…A wait time exceeding 12 months from consultation to surgery may adversely affect the 12-month outcomes after THA [13,14,24]. Based on our results, long wait times are not free from adverse effects and have irreversible effects on the results of the therapeutic intervention.…”

“…We found several factors related to quality of life that decreased when adjusted by other related variables, resulting in the ultimate determination of the waiting time: the degree of pain and function. Pain and function are crucial criteria in the prioritization process for THA [13]. As previously reported [17,22], the prioritization process should be based on broader criteria.…”

“…A review of initiatives for using priority criteria shows the benefits of their application, such as greater transparency and increased equity of the procedure, driven by clinical need and under physician control [13].…”

“…The ability of THA to improve function and reduce pain is well documented, and priority criteria for management of waiting lists for this surgery have been proposed [13,17]. Nevertheless, these criteria often are not followed in clinical practice [19,31], which often results in unclear wait-list management procedures.…”