A few months ago, I wrote a column entitled, “How do you know when you are ready for a new knee?” I received several emails with requests for more information regarding hip and knee replacements such as, outcomes, complications, etc. Some readers wanted to know about heart disease and joint replacements. One reader wanted to know about outcomes for obese patients. Another was concerned about the ability to return to work following a joint replacement. And, one reader asked about the special knee replacement made just for women. Research on these topics and others were presented at the American Academy of Orthopedic Surgeons 2013 Annual Meeting in Chicago. But, while research is valuable, please keep in mind that each person is unique and there is no substitute for productive discussions with your primary care physician and orthopedic surgeon.
A recent study looked back and examined more than 43,000 patients with osteoarthritis of the hip from 1998 to 2009. They discovered that, in addition to the well known short term benefits of joint replacement, there are many surprising long term benefits. Short term, it is known that joint replacements improve quality of life with reduced joint pain. Long term, they discovered that patients who had a total hip replacement had a lower mortality rate than those without replacements. These patients also had a lower risk of diabetes and depression. Researchers concluded that the long term benefits may be due to increased activity with less pain and improved mobility. The more active lifestyle may contribute to longevity and quality of life.
8,000 joint replacement patients were studied for differences in outcomes and complications between those who were obese and non-obese. Long term outcomes such as pain, range of motion, and quality of life were similar. Also, complication rates among obese patients were not higher if the patients did not have additional medical conditions, often associated with obesity, such as diabetes and high blood pressure. However, if these additional problems were present, then obese patients experienced longer and more expensive hospital stays and increased infection rates. Despite this, long term outcomes were satisfactory.
Due, in part, to an increased number of younger, working-age patients, receiving total joint replacements, researchers wanted to know if they were able to return to preoperative employment. 98% of patients with total knee replacements returned to previous employment for those employed three months before surgery. The return rate was as follows: 92% for sedentary, 79.% for light, 89.% for medium, 87.% for heavy and 78.% very heavy jobs.
Return to lifestyle was also explored. Before surgery, almost 40% of the patients reported an active lifestyle. Post surgically, an additional 16% of the patients were active. It was concluded, those who were active before surgery will return to activity and many others will regain an active lifestyle in activities such as; bowling, golfing, walking, and swimming. Additionally, many active patients return to more vigorous activities such as golfing, biking, hiking, tennis and skiing and hiking.
60% of all knee replacements occur in women and the female knee is shaped slightly different than that of a male. However, it has not been confirmed that the new “gender specific” knee replacement improves outcomes. In a large study group, while it was determined that the gender specific knee group appeared to have a better fit on follow-up x-ray, there were no differences in knee range of motion, pain, or function. Researchers concluded, at this time there are no disadvantages to the gender specific knee replacement and choosing the right size implant for the specific patient, regardless of gender, is important for positive outcomes. Therefore, the gender specific knee replacement provides more choices for the surgeon and patient to determine the best fit for the best possible outcome.
SOURCE: American Academy of Orthopedic Surgeons 2013 Annual Meeting in Chicago.
Visit your doctor regularly and listen to your body.
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in the Scranton Times-Tribune.
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice in downtown Scranton and is an associate professor of clinical medicine at The Commonwealth Medical College.
