Joint replacement outcome studies – patient dissatisfaction remains as high as 50%

Category: Blog

Hip replacement obesity

Despite an overall positive view of  hip or knee replacement outcomes, some research suggests that up to 19% of patients are not satisfied with their knee replacement outcomes for various reasons including lack of desired weight loss.

  • This is from the medical journal Orthopedics – New research says that the number of patients not satisfied should be much higher than 19%- “Although total knee replacement is a successful and cost-effective procedure, patient dissatisfaction remains as high as 50%”1
  • In the British Medical Journal, researchers from the University of Bristol in the United Kingdom found the problem of pain after knee replacement profound enough to call for a new research priority – helping people with pain after knee replacement.
    • “As a large number of people are affected by chronic pain after total knee replacement, development of an evidence base about care for these patients should be a research priority.”2

The reasons for getting knee replacement?

Patients who debate whether or not to get a knee replacement give three primary reasons:

  • Reduce pain
  • To be more active
  • Lose weight gained from inactivity

Joint replacement – weight loss myth

New research is suggesting that knee replacement patients gain more weight after the surgery. Worse, the younger the patient, the greater the risk for substantial weight gain following the surgery! 3

In other research, it becomes a little more clear “Total hip or knee replacement patients who are overweight or obese often consider their disabling joint disease a cause for their increased weight. . . (This) study investigated weight change in 100 patients after successful total joint replacement to determine whether surgical treatment of hip or knee arthritis leads to weight loss reduction. Postoperatively, both hip and knee replacement patients gained weight…” 4

And finally, doctors at  the Joint Replacement Institute at Orthopaedic Hospital, Los Angeles wrote: “These findings demonstrate successful treatment of lower-extremity arthritis (a “successful joint replacement” does not lead to weight loss, and obesity should be treated as an independent disease that is not the result of inactivity from arthritis.”5

  • All three studies seemingly confirm the same thing, it is up to the doctor and patient who are predisposed for weight gain, to work together to form a non-weight gaining plan before and following treatment.

Surgery to fix knee and hip replacement in dissatisfied and in pain patients

Recently the Hospital for Special Surgery released a report “What Patients Need to Know About Revision Surgery After Hip or Knee Replacement” on possible complications in hip and knee surgery – they include:

  • Loosening of the implant. The hip or knee replacement may become painful after many years because the components have begun to wear and loosen.
  • A fracture. A fall or severe blow can cause a fracture of the bone near the hip or knee replacement.
  • Dislocation. If the implant dislocates on repeated occasions, revision surgery is often needed to stop this from happening.
  • Infection. If a deep infection develops in a hip or knee replacement, revision is often needed to eradicate the infection and to implant new non-infected components.
  • Implant recall. On occasion, the implant used in joint replacement is found to have a problem and patients who received the implant are advised to be monitored by their physician to make sure it does not need replacement. Revision surgery is sometimes necessary when an implant is recalled.

In the Journal of Arthroscopy one study said not only complications are a problem – but expectations are sometimes disappointing:

In this study, patients who had a knee replacement were studied for the frequency, intensity, and duration of actual vs expected leisure activity:

“Despite high expectations, there were statistically and clinically significant differences between actual and expected activity at 12 months suggesting that expectations may not have been fulfilled. The differences were equivalent to walking 14 less miles per week than expected, which is more than the amount of activity recommended in national physical activity guidelines. Perhaps an educational intervention could be implemented to help patients establish appropriate and realistic leisure activity expectations before surgery” 6

This investigation agreed with another paper where researchers showed that a majority of patients do have high expectations regarding joint replacement surgery. As these expectations are not always met, a straight forward physician-patient communication is necessary to prevent patients from potentially unrealistic expectations and dissatisfaction with the surgery outcome.7


But what is causing the continued knee pain, and why do they think these therapies may be the best option?

Doctors and researchers have noted that a main cause for the “need” for secondary knee surgery was knee ligaments injured or weakened by the primary surgery itself. Here is what one group of researchers found:

In following one hundred and thirty-five patients who had a “revision” or secondary surgery, doctors found that in nearly one-third of the cases (32.6%) knee ligament instability was the primary reason for the follow-up surgery.3

In another one out of 5 patients, ligament instability was identified as the secondary reason for revision. So in more than 50% of patients needing a secondary surgery, ligament instability was the primary or secondary cause. 4

In elderly patients who are sports minded, there is a belief that the joint replacement will allow them to participate again in sports. This is not the case in all patients. In one paper doctors found that counselling on sports activities following joint replacement was lacking in  patients with previous sports experience and the patient’s expectation of a successful replacement surgery was not met.7

After a physical examination, we find another leading cause of revision knee surgery is that only one part of the damaged or degenerated knee was addressed. Often ligament weakness will appear with meniscus damage, yet only the meniscus damage will be treated.

We have published many articles on knee surgery alternatives for ligament laxity, osteoarthritis, cartilage repair, and other injuries at knee surgery alternatives

Do you have questions about knee pain pre or post-surgery?


Call US  856-324-6033
OR email us at:  info@DrMagaziner.com


References
3 Jones DL, Bhanegaonkar AJ, Billings AA, et al. Differences Between Actual and Expected Leisure Activities After Total Knee Arthroplasty for OsteoarthritisJournal of Arthroscopy
4. Graichen H, Strauch M, Katzhammer T, Zichner L, von Eisenhart-Rothe R. [Ligament instability in total knee arthroplasty – causal analysis.] Orthopade. 2007 Jun 21;

Often a patient will come in with a history of one or more knee surgeries and the hope of avoiding another by using Prolotherapy, Platelet Rich Plasma Therapy, or Stem Cell Treatments, depending on the level of knee deterioration they are suffering from.

Knee and hip replacement patient expectations failure

Realistic goals following joint replacement is especially important in patients with existing medical conditions. Researchers in the Journal of Clinical Nursing have offered an opinion that patients with cardiovascular problems do not feel that their quality of life changed regardless of the success of the procedure.

The research study team sought to evaluate to what degree total hip replacement, or co-morbidities or their progression, influence the health-related quality of life of patients after the operation. They looked for an objective method to reflect the severity of cardiovascular diseases and to better characterize the health-related quality of life of patients with total hip replacement.

The concluded: “After successful total hip replacement postoperative health awareness is influenced mainly by existing and developing cardiovascular diseases. It seems to be the case that for patients with significant hypertension, ischaemic heart disease or chronic heart failure, even successful surgery will not improve the patients’ overall feeling of health.”9


1 Park CN, White PB, Meftah M, Ranawat AS, Ranawat CS. Diagnostic Algorithm for Residual Pain After Total Knee Arthroplasty. Orthopedics. 2016 Mar 1;39(2):e246-52. doi: 10.3928/01477447-20160119-06. Epub 2016 Jan 25.

2 Beswick AD et al.  Interventions for the prediction and management of chronic postsurgical pain after total knee replacement: systematic review of randomised controlled trials. BMJ Open. 2015 May 12;5(5):e007387. doi: 10.1136/bmjopen-2014-007387.

3. Riddle DL, Singh JA, Harmsen WS, Schleck CD, Lewallen DG. Clinically important body weight gain following knee arthroplasty: A five-year comparative cohort study. Arthritis Care Res (Hoboken). 2012 Nov 30. doi: 10.1002/acr.21880. [Epub ahead of print]

4. Stets K, Koehler SM, Bronson W, Chen M, Yang K, Bronson M. Weight and body mass index change after total joint arthroplasty. Orthopedics. 2010 Jun 9;33(6):386. doi: 10.3928/01477447-20100429-13.

5. Heisel C, Silva M, dela Rosa MA, Schmalzried TP. The effects of lower-extremity total joint replacement for arthritis on obesity. Orthopedics. 2005 Feb;28(2):157-9.

6. Jones DL, Bhanegaonkar AJ, Billings AA, et al. Differences Between Actual and Expected Leisure Activities After Total Knee Arthroplasty for Osteoarthritis.

7. Koenen P, Bäthis H, Schneider MM, et al. How do we face patients’ expectations in joint arthroplasty? Arch Orthop Trauma Surg. 2014 Jul;134(7):925-31. doi: 10.1007/s00402-014-2012-x. Epub 2014 May 24.

 

8. Király E, Gondos T. Cardiovascular diseases and the health-related quality of life after total hip replacement. J Clin Nurs. 2012 Jul 11. doi: 10.1111/j.1365-2702.2012.04101.x. [Epub ahead of print]