| arthritis (OA) is the most common form of arthritis. It | | | | demonstrates that elderly patients with hip or knee |
| affects approximately 40 million Americans and that | | | | replacements for severe OA took several weeks to |
| number is predicted to rise with the change of | | | | recover but experienced excellent long-term |
| demographics occurring as the Baby Boomers age. | | | | outcomes. |
| OA is a disease of articular cartilage, the gristle that | | | | The study was designed as a prospective study to |
| caps the ends of long bones and is most common in | | | | examine decision making and clinical outcomes for |
| weight-bearing joints such as the hips, knees, neck, | | | | elderly patients. There were 174 patients entered |
| low back, base of the thumbs, and great toe joints. | | | | into the trial and all were over the age of 65 years. |
| The treatment regimen for this condition has not | | | | Patients had either OA of the hip or knee. |
| changed appreciably for several years. Among the | | | | OA symptoms and functional status were assessed |
| various treatment options are | | | | at baseline and at 12 months. |
| non-steroidal-anti-inflammatory drugs, local measures | | | | Postoperative symptoms and function were |
| such as ice, joint injections consisting of either | | | | assessed at 6 weeks, 6 months, and 12 months |
| glucocorticoids (“cortisone”), and joint | | | | after surgery. |
| injections of viscosupplements, lubricants that help | | | | Of the patient group, 76% were female, 17% were |
| ease the pain and which also help with improved | | | | nonwhite, 69% had knee OA, and 31% had hip OA. |
| function. | | | | During a 12-month follow-up, 29% had joint |
| Assistive devices such as canes and walkers may be | | | | replacement surgery. |
| useful. | | | | Of the patients who had surgery, no patients died, |
| Other treatments such as arthroscopic debridement | | | | 17% had postoperative complications, and 38% had |
| have also helped in some instances. | | | | postoperative pain lasting longer than 4wks The |
| For younger patients (between the ages of 30 to | | | | median time to recovery for independent walking |
| 60), stem cell therapy appears to be growing in | | | | was 12 days. The median time to be able to perform |
| enthusiasm. | | | | household chores was 49 days. |
| Unfortunately, when the cartilage has completely | | | | At 12 months, scores assessing ability to perform |
| worn away, the options become limited. Total joint | | | | activities of daily living improved by 24 points in the |
| replacement surgery then appears to be one of the | | | | patients who had surgery and 0.5 points in the |
| few choices remaining. | | | | patients who did not have surgery. |
| While total joint replacement may be an option for | | | | Improvements were 19 and 0.3 points in patients |
| patients under the age of 65, there has been little | | | | older than 75 years of age. |
| data regarding what to do for patients who are older | | | | Among patients who did not have surgery, 45% |
| and who need joint replacement. | | | | reported that surgery was not offered as a potential |
| Some patients are fearful of complications and many | | | | treatment option. |
| physicians are reluctant to advise patients to have | | | | This study demonstrates that total joint replacement |
| the surgery because of fear of potentially poor | | | | surgery may be a viable option for many older |
| outcomes. | | | | patients and should not be dismissed as an option |
| A recent study published in July 2008 by Hamel MB | | | | just because of a patient’s age. |
| et al in the Archives of Internal Medicine | | | | |