I have arthritis – will I need a joint replacement?

Article Review: The Course of pain and function in osteoarthritis and timing of arthroplasty: CHECK cohort

Gademan et al.

Published in Acta Orthopaedica, October 2018, 89(5):528-534.

Osteoarthritis (OA) is a very common age-related condition which is sometimes treated using joint replacement surgery. Surgical options and techniques have continued to improve over the past few decades, but synthetic joints do not last forever. The earlier in a person’s life they have a joint replaced, the greater the likelihood they may need more complicated surgery later to revise the replacement.

The CHECK cohort study followed a large group of 868 patients with painful hip or knee osteoarthritis to examine how their symptoms progressed over a nine-year period, and to identify what factors determined if or when they had a joint replacement. The patients’ pain level, functional capacity and X-ray images were tracked periodically from their first GP visit across the nine-year period.

On average, across the whole patient group, measures of pain and function tended to remain relatively stable and consistent across the nine-year period. Any episodes of ‘flare up’ were typically followed by improvement. A total of 84 patients underwent joint replacement surgery. These patients’ measurements showed higher pain levels, worse functional capacity and more degenerative changes on X-ray, both at baseline and throughout the study period.

These findings indicate that when knee or hip OA is painful, it is the overall severity of the symptoms which increase the likelihood of having a joint replacement, rather than the rate at which these symptoms increase over time. As OA symptoms appear to remain reasonably stable over time, it may be beneficial to postpone primary joint replacement surgery to lower the future risks of revision surgery.