Lack of Social Ties Linked to Pain after Hip Replacement

Total hip replacement surgery outcomes affected by social isolation

(RxWiki News) If you're a social butterfly, it may do you some good if you're about to undergo hip replacement surgery.

A recent study found that socially isolated people were more likely to have serious pain two or more years after total hip replacement surgery.

Socially isolated people don't have many close contacts. That means they have fewer than six family members or friends, aren't married and don't belong to local or religious organizations.

"Ask your surgeon how to prepare for hip replacement surgery."

This study was conducted by Lisa Mandl, MD, MPH, a rheumatologist at the Hospital for Special Surgery in New York City, and colleagues.

“Previous studies have shown that social isolation is a risk factor for poor health outcomes,” said Dr. Mandl in a press statement.

“Studies show that people who don’t have good social ties are at increased risk of suffering a heart attack or stroke, and even dying, compared to those who enjoy the social support of family, friends and the community," she said.

For this study, Dr. Mandl and her team looked at cases from a registry of more than 12,000 people who had hip replacement surgery for osteoarthritis (OA) or rheumatoid arthritis (RA) from May 2007 to February 2011. Charts were reviewed for age, sex, procedure type and year of surgery.

A total of 934 patients of an average age of 62 received the survey. Responses included a total of 146 out of 223 patients with RA (65.5 percent) and 541 of 711 patients with OA (76.1 percent).

Both groups had similar demographics and percentages of very socially isolated patients — 8.2 percent for RA and 7.8 percent for OA.

Researchers collected patients' demographic information and evaluated their pain and function before surgery and two to five years after surgery using a questionnaire that assesses physical function, pain and stiffness called the Western Ontario and McMaster Universities Arthritis Index (WOMAC).

The Berkman-Syme Social Network Index, which measures social integration, was also given two to five years after the operation. 

Social isolation was associated with an almost three times increased risk for having worse pain after surgery than those who weren't isolated.

Social isolation appeared to be more significant in OA, a patient group that makes up the majority of hip replacement cases.

RA was associated with poorer function after surgery, not more pain.

“We believe further prospective studies should be done to determine whether interventions to evaluate and improve patients’ social ties before surgery could lead to a better pain outcome after hip replacement,” Dr. Mandl said.

“It could be a way to improve outcomes without medication or other costly interventions. I see no downside to helping patients get the social support they may need to improve their quality of life,” she said.

This study will be presented at the American College of Rheumatology/Association of Rheumatology Health Professionals annual meeting on October 29 in San Diego, California.

The researchers did not disclose any financial conflicts.

Review Date: 
October 24, 2013