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The Best Time for Hip Replacement Surgery Is . . . Still Unclear

Posted on: 11/30/1999
Total hip replacement is a serious surgery. It is the last stage of treatment when hip pain or disability has finally become unmanageable. Deciding when to have hip replacement surgery is difficult. Each patient makes the decision depending on his or her own health, lifestyle, and fears. It would be helpful if doctors had a clear set of data to help patients understand the risks and benefits of hip surgery at different stages--but they don't.

These authors tried to fill in some of the gaps in the data. They surveyed 1120 Medicare patients in 12 states who had hip replacement surgery because of osteoarthritis. Patients were asked about their activities and pain level before surgery and during the year after surgery. The idea was to see if patients' status before surgery could predict outcomes a year after surgery.

The results were mixed. People who had the most pain and the poorest function before hip surgery still had the most pain and disability a year later. This was especially true for the people who had needed help with walking, housework, or shopping before surgery. Most of them still needed help with those activities.

The authors weren't sure why this was true. Maybe the condition of these patients had gotten so bad that surgery couldn't help them very much. It is also possible that they had gotten used to the help and found it hard to go back to doing things on their own. But not all the news was bad for the group with the poorest function before surgery. They showed the greatest reductions in pain and disability levels after surgery.

So how can this information help patients decide when to have surgery? It doesn't give a clear forecast. But it does suggest that waiting until patients need help with daily tasks is not a good idea, even if these patients can still benefit from hip replacement surgery.

Jeremy Holtzman, MD, MS, et al. Effect of Baseline Functional Status and Pain on Outcomes of Total Hip Arthroplasty. In The Journal of Bone and Joint Surgery. November 2002. Vol. 84-A. No. 11. Pp. 1942-1948.

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