When to Have That Joint Replacement?

Hispanic and African-American patients tend to have poorer joint function before undergoing hip or knee replacement surgery, according to a new study presented today at the 2009 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS). In addition, female patients have less preoperative joint function than male patients across ethnic groups.

“Studies have shown that the timing of joint replacement surgery is an important determinant of outcome,” says James Slover, M.D., M.S., an orthopaedic surgeon at New York University Hospital for Joint Diseases. “This means that patients with worse joint function before surgery do not do as well after the surgery.”

Researchers reviewed the pre-surgical joint function of more than 3,500 hip and knee replacement patients based on physical exams and questionnaires. This information comprises the functional components of the Harris Hip Score and the Knee Society Score, which were used to quantify the functional ability of all the patients. They found:
• Even when adjusted for patient age, Hispanic and African-American patients had worse joint function before the surgery.
• In particular, Hispanic men had worse function prior to knee and hip replacement than both African-American and Caucasian men.
• Hispanic and African-American women had significantly worse function prior to hip replacement than Caucasian women.
• Women demonstrated lower preoperative hip and knee function when compared with men of the same ethnicity. 

The reasons for these disparities, Dr. Slover says, are unclear.

“As a next step, we need to try and understand why certain groups tend to wait longer before have surgery,” he says. “Do they have less access to the necessary care? Is it an insurance issue? Is there something in their culture or mindset that makes them wait longer before pursuing treatment?

We need to know why this occurs, because if it is an issue of outreach and education, we as orthopaedic surgeons can help address the problem and help patients get the appropriate care and treatment.”

Joint replacement, also known as arthroplasty, is considered by many to be one of the most successful medical innovations of the 20th century. Total joint replacement is a surgical procedure in which the patient’s natural joint is replaced with an artificial one, made of a combination of plastic, metal, and/or ceramic.

The most common reasons for this surgery are pain and stiffness that limits normal activities such as walking and bending and that cannot be satisfactorily treated with medications or other therapies. Therefore, joint replacement surgery often provides a significantly improved quality of life to patients who would otherwise have to live with severe pain.

More than 400,000 primary total hip and knee replacements are performed each year in the United States, and that number is on the rise—particularly as the Baby Boomer population continues to age. Because of this trend, it is important to optimize patient outcomes.

Disclosure: Dr. Slover and his co-authors received no compensation for this study.

Source: American Academy of Orthopaedic Surgeons (AAOS)

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