Osteoarthritis

Study challenges trend for joint surgery in younger patients


1 in 3 people who undergo joint replacement surgery in their early 50s will require revision surgery in their lifetime, research shows.

The Lancet study of 63,158 patients with hip replacements and 54,276 with knee replacements found that for patients aged 50–54 years, the lifetime risk of revision (LTRR) surgery increased up to 29% for patients with hip replacements and 35% for those with knee replacements.

Large differences were observed between male and female patients, with the lifetime risk of revision approximately 15% lower for women.

This compared to a lifetime risk of revision of about 5% in those who had their surgery after 70 years of age, with no difference seen between sexes.

“A patient in their 50s with a potential life expectancy of more than 30 years could spend many years living with a revision joint replacement with limited functional ability,” the study authors from the Nuffield Department of orthopaedic and rheumatology and musculoskeletal science wrote.

With a trend to joint replacement surgery in younger patients, the researchers questioned the significant economic impost on any health system, they said.

Dr Lawrie Malisano, vice-president of the Australian Orthopaedic Association, told the limbic reducing the risk of revisions was an important goal that was facilitated in Australia by data from the National Joint Replacement Registry

“The best way to do this is to provide information to surgeons on the risks of revision for specific patient groups and what is the best way to reduce this.”

“Revision is a major procedure which is much more costly than undertaking the initial joint replacement. It is also associated with a much higher rate of complications and the results of the surgery are not as good as an initial joint replacement procedure.”

However, he said unlike overseas, the risk of revision in Australia for both hip and knee replacement has been decreasing every year since the registry was established and estimated to have saved over $600 million.

An accompanying Comment in The Lancet said postponing hip and knee replacements should be considered more often.

“The current trend to implant total hip and knee implants in ever younger patients, driven by the fact that short-term outcomes in the first few years after surgery are mostly acceptable, could lead to many patients ceasing to be revisable, and these patients might become a large burden to society in terms of cost and disability,” the authors wrote.

However Dr Mailsano said there would always be younger patients with no alternative to a joint replacement because of the severity of their disease.

“What is then essential in this circumstance is that surgeons are fully aware of the best possible options to optimise the outcome of this surgery. Unfortunately this article does not address this issue,” he said.

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