Surgical Replacement: Younger vs. Older Knees and Hips
SOURCE: Bayliss LE, et al. Lancet 2017;389:1424-1430.
Most patients I have seen who have undergone hip or knee replacement experienced prompt restoration of function and marked reductions in pain. In advanced osteoarthritis sufferers who are as yet untreated surgically, the question often becomes “Should I do it sooner or later?” Waiting until later often entails enduring a significant symptom burden as well as limited mobility; doing it sooner may feel premature to patients with moderately disabling symptoms.
Bayliss et al provided substantiation for “doing it later” (i.e., later by one’s chronologic clock). They assessed data on more than 63,000 individuals who had undergone hip or knee replacement. Hip and knee replacements were shown to be very durable, in that more than 95% of hip or knee replacements were functioning 10 years later, and more than 85% were functioning 20 years later.
However, when specifically looking at the relationship between age at intervention and need for revision, they found that study subjects > 70 years of age who underwent joint replacement surgery experienced a seven-fold lower incidence of revision than patients ≤ 50 years of age (5% lifetime revision rate for the former vs. 35% for the latter). Although the joint replacement decision always should be individualized, these data suggest that we inform potential subjects of the greater likelihood for repeat surgery if initial surgery is performed on patients < 70 years of age.
Data suggest that clinicians inform potential subjects of the greater likelihood for repeat surgery if initial replacement surgery is performed on patients < 70 years of age.
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