Should you delay a hip replacement surgery?

Should You Delay a Hip Replacement Surgery?

In all procedures of elective nature, both physicians, as well as patients, have an opportunity to weigh the benefits of undergoing a surgery vis-a-vis avoiding it. Many patients prefer to delay a surgery until they can no longer bear the pain, or when other treatment options begin to fail and cause other serious side-effects. Every surgery, no matter however minor comes with certain risks, so it’s quite natural to believe that a patient would prefer to delay it. In words of the famous surgeon, John Hunter, also known as the father of modern surgery, surgery should be the last resort. But evidence from the latest medical research suggests that when surgery is inevitable and has to be done sooner or later, its best to carry it out instead of waiting for conditions to become worse.

Patients suffering with Osteoarthritis and with damaged joints such as knee and hip often find themselves in a dilemma on whether to continue with conventional treatments such as pain relief medications, physiotherapy etc. or undergo a joint replacement surgery. The natural tendency of any patient is to avoid a replacement surgery for as long as possible, but literature is beginning to suggest that it is not a prudent approach.

An interesting study was carried out in the United States that included a sample of 1000+ Osteoarthritis patients of 65+ years of age and from as many as twelve different states.1 All of these patients were strictly Osteoarthritis affected patients. Other patients who had a damaged joint due to other diseases such as rheumatoid arthritis or required replacement as a result of a fracture were excluded from the study.

The primary goal of this study was to assess the nature of outcome after a hip replacement surgery on the basis of pre-operative conditions. All of the patients in the study sample were interviewed prior to their surgery, and several measurements were recorded such as their co-morbidity index called Charlson index, the level of pain, daily activity level, the ability to walk with or without assistance etc. Following a hip replacement surgery, each of the patients was again interviewed and assessed for a period of 2 months, 6 months and 12 months.

Several interesting patterns emerged after analyzing the pre-operative and post-operative conditions of these patients. Patients who reported pain or severe pain while walking, or had a need for assistance while walking, had lower than normal daily activity were more likely to show the same disability even after one year of surgery.

For instance, of the total patients who couldn’t walk greater than 1 mile before surgery, 29% could still not walk that distance after one year. Compare this with the fact that 81% of patients who could walk greater than 1 mile before surgery could walk that far even after surgery. Similarly, in terms of the severity of pain, if a patient had severe pain while walking, he or she was more likely to have a severe pain even after one year of surgery (38% vs 9%).

What this study concludes is that, if you are an Osteoarthritis patient with damaged joints that sooner or later will need to be replaced, you are much better off undergoing the joint replacement surgery than postponing it till your condition worsens even further.  At the same time, be aware of the sample of patients included in this study i.e. 65+ years of age. Why? Because if you are too young, having a joint replaced may not be that great an option because the life of a replaced joint typically lasts 15-20 years. Having to undergo yet another replacement in future may not be that great of an idea.

Despite the availability of several such studies that indicate that better post-surgery outcomes can be expected when the pre-surgery condition is better, it’s still very hard for both physicians and patients to decide when to undergo a joint replacement. Why? Because it’s not easy for anyone to predict the rate at which disability caused by a damaged joint will progress. Still, it’s worthwhile for such a patient to routinely undergo diagnostic procedures to assess his or her condition. If the condition is worsening progressively, a surgery may be in order!

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References

  1.  Effect of Baseline Functional Status and Pain on Outcomes of Total Hip Arthroplasty, Holtzman, Jeremy; Saleh, Khal; Kane, Robert, Journal of Bone and Joint Surgery, Volume 84 (11): 1942 – Nov 1, 2002

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