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Decision Making, Postoperative Recovery, and Clinical Outcomes

Mary Beth Hamel, MD, MPH; Maria Toth, MD, PhD; Anna Legedza, ScD; Max P. Rosen, MD, MPH

Arch Intern Med. 2008;168(13):1430-1440.

Background  Osteoarthritis (OA) of the hip and knee is a common cause of pain and disability in elderly patients. Joint replacement surgery can alleviate pain and restore function but is associated with risks and discomfort.

Methods  We conducted a prospective cohort study to examine decision making and clinical outcomes for elderly patients (age 65 years) with severe OA of the hip or knee with symptoms inadequately controlled with conservative treatments. Osteoarthritis symptoms and functional status were assessed at baseline and at 12 months. Postoperative symptoms and function were assessed 6 weeks, 6 months, and 12 months after surgery.

Results  For the 174 patients studied (mean age, 75 years; 76% were female, 17% were nonwhite, 69% had knee OA, and 31% had hip OA), the mean Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score was 56 on a 100-point scale. During a 12-month follow-up, 29% had joint replacement surgery. Of patients who had surgery, no patients died, 17% had postoperative complications, and 38% had postoperative pain lasting more than 4 weeks. The median time to recovery of independence in walking was 12 days and to ability to perform household chores was 49 days, with similar times for patients 65 to 74 years old and those 75 years or older. At 12 months, WOMAC scores improved by 24 points in the patients who had surgery and 0.5 point in the patients who did not have surgery (P < .001); improvements were 19 and 0.3 points in patients 75 or older (P < .001). Among patients who did not have surgery, 45% reported that surgery was not offered as a potential treatment option.

Conclusions  Elderly patients who had hip or knee replacements for severe OA took several weeks to recover but experienced excellent long-term outcomes. Physicians often do not discuss joint replacement surgery with elderly patients who might benefit.

Author Affiliations: Division of General Medicine and Primary Care (Drs Hamel, Toth, and Legedza) and Department of Radiology (Dr Rosen), Beth Israel Deaconess Medical Center, Boston, Massachusetts.

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