Joint Replacements Go to Pragmatic Disabled Patients

TORONTO, Sept. 28 -- Patients with disabling osteoarthritis who consider a knee or hip replacement to be a realistic option are more likely to become a recipient of one than those who are of two minds, Canadian researchers said.

Willingness to consider undergoing surgery is by far the most important determinant of time to knee or hip replacement among disabling osteoarthritis patients, at least among those in the national healthcare system here, according to a study in the October 2006 issue of Arthritis & Rheumatism.

Individuals who were willing to consider total joint arthroplasty were four times more likely to undergo surgery than those with similar arthritis severity and health status who were unsure or unwilling to have surgery.

Prior research suggested misperceptions of joint replacement's indications largely explained unwillingness, which emphasizes the need to educate patients "about the success of total joint arthroplasty in the 'well elderly' and current projections for prosthesis survival following surgery in younger individuals," wrote Gillian A. Hawker, M.D., M.Sc., of Women's College Hospital here, and colleagues.

While 31.0% of the participants who were willing to undergo surgery did so, 10.4% of those who were unsure or unwilling ultimately had joint replacement during the study period. In multivariate analysis, the hazard ratio was 4.92 for those who were willing versus those who were not (95% confidence interval 3.73 to 6.44, P

Although age and sex were not significant predictors, "this should not be considered evidence that disparity in access to total joint arthroplasty does not exist," wrote the authors. Rather, the influence of sex and socioeconomic status may be mediated by willingness to consider surgery, which is directly related to the probability of undergoing joint replacement, they suggested.

The predictors of time to hip replacement did not differ from those for time to knee replacement.

The researchers acknowledged that the results may not be generalizable to other countries with different health care systems.

The study was supported by the Canadian Institutes of Health Research.