Healing and Surviving After Knee and Hip Replacements

Knee and hip replacement recovery among osteoarthritis patients affected by psychotic disorders and other health conditions

(RxWiki News) For some people with aching bones and joints, knee or hip replacement surgery may be a treatment option. But pre-existing conditions may affect how a patient responds to surgery.

A recent study found that joint replacement patients with certain pre-existing conditions had a greater risk of having a second surgery or not surviving the next one to 10 years than patients without such disorders.

These pre-existing conditions included heart disease, diabetes and psychotic disorders.

The researchers suggested that health conditions that are not necessarily related to a patient's knees or hips could affect how they survive and heal from knee and hip replacements.

"Before joint replacement surgery, tell your surgeon about any conditions you have."

Esa Jämsen, MD, PhD, of the Hospital for Joint Replacement in Finland, led this study to see how existing conditions affected how patients recover from hip and knee replacements.

Dr. Jämsen and colleagues looked at data from patients who had a hip or knee replaced due to osteoarthritis. These researchers examined the patients' health conditions, survival rates in the years after surgery and whether they had to have a second "revision" surgery.

Osteoarthritis is a condition in which the patient's joints become painful, stiff and tender due to wearing down from use. People with severe osteoarthritis sometimes choose to undergo knee or hip replacements to relieve the pain and improve function.

According to the authors of this study, knee and hip replacements are normally safe and effective. However, some patients have poorer survival rates after these procedures, while others must undergo revision surgery later to repair the new hip or knee.

To see if those outcomes were linked to pre-existing health conditions, the researchers looked at data on patients who had knee or hip replacements due to osteoarthritis from 1998 to 2008.

In total, they studied 43,747 patients who had undergone a total hip replacement and 53,007 patients who had a total knee replacement.

The researchers looked to see which patients had heart disease, high blood pressure, diabetes, cancer, lung disease, depression, psychotic disorders and diseases of the brain like Alzheimer's or Parkinson's.

During the follow-up period, which was an average of 4.9 years for hip patients and 4.4 years for knee patients, 2,131 patients had to undergo hip replacement revision surgery and 1,919 underwent knee replacement revision surgery.

A total of 98.8 percent of the hip and knee replacement patients had survived one year after surgery. A total of 91.9 percent of hip replacement patients and 94.5 percent of knee replacement patients survived for 10 years.

Patients with heart disease were more at risk of revision joint replacement than patients with healthy hearts. High blood pressure and diabetes increased the risk for early revision of a knee replacement.

Additionally, a history of cancer was associated with a lower survival rate for hip replacement.

Patients with depression or psychotic disorders like schizophrenia or mania had high revision rates. More than 10 percent of these patients had to undergo revision surgery.

The researchers noted that the study could not take into account important details like physical activity and obesity, both of which could affect survival and revision rates.

They concluded that pre-existing diseases like heart disease, diabetes and psychotic disorders may affect how well a patient heals from knee or hip replacement. The authors of the study called for further research on surgery outcomes for patients with health conditions.

This research was published in December issue of the Annals of the Rheumatic Diseases.

Funding information was not available. The authors declared no support from organizations for the work.

Review Date: 
November 4, 2013