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When Should I Have a Joint Replacement?

by Jose Fernando Syquia, MD, FPOA

     A joint damaged by arthritis can be very difficult for a person. Not only is there pain, but also stiffness and swelling. Due to our natural tendency to avoid pain, a person suffering from hip or knee arthritis will, consciously or subconsciously, slowly cut down on his daily activities. Before long, his relatives and friends notice that he is not as lively as he once was and that he is not able to walk for long distances.

    There are many ways to treat a joint damaged by arthritis. One method is through a type of surgery known as a joint replacement. Due to long standing pain that could not be controlled by other means, former President Joseph Estrada had his knees replaced. After his successful operation, more and more people became aware of the benefits that such a procedure can give.

     But when should one have a joint replacement? Should one have it done early in the disease? Or should one wait until he is just about to be condemned to a wheelchair because of the pain? Does it make a difference when the joint is replaced?

     In a study by Fortin, et. al. published in the scientific journal Arthritis and Rheumatism (Timing of Joint Replacement Affects Clinical Outcomes Among Patients with Osteoarthritis of the Hip or Knee) in which they looked at the 2-year outcome of 165 patients who underwent a hip or knee replacement, they noted that all their patients improved after the surgery. However, they pointed out that patients operated on earlier in the course of their disease and before any functional decline had better outcomes.

    In a study published in the Journal of Arthroplalsty (Do Patients Need to Earn Total Knee Arthroplasty), Gidwani, et. al. looked at the results of 130 knee replacements.  According to them, knee replacement is the treatment of choice for those patients whose symptoms have not been controlled by non-operative measures. However, it appeared that although patients with more severe symptoms of functional decline prior to surgery benefitted more in absolute terms after the procedure, they were also less able to recover their function when compared to those patients who had less severe symptoms.

     A study by Holtzman, et. al., published in the Journal of Bone and Joint Surgery (Effect of Baseline Functional Status and Pain on Outcomes of Total Hip Arthroplasty), examined the effect of baseline pain and functional status on the outcome of hip replacement in 1120 patients. Their results also showed that patients with worse preoperative functional status generally also had worse outcomes in terms of function and pain after a hip replacement. Furthermore, although patients with worse baseline scores derived the most benefit after surgery, the outcome scores were not as great as those who had better baseline scores. Put another way, the final result of surgery may be worse if the procedure is put off to a time when the preoperative functional status is worse.

     These studies show us that if a joint replacement is done when functional decline has started, the risk of a poorer outcome is greater. Patients who have their surgery at a later date will still improve a lot, but not to the level of one who had the surgery earlier.

     So, is there a correct time when a person suffering from hip or knee arthritis should have his joint replaced? Unfortunately, there is none.  Timing for the procedure should be discussed with one’s physician in the context of disease severity, functional impairment, pain, and treatment received so far. But if surgery were needed, it would be better to have it sooner than later.  

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