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