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We at The Centre for Hip and Knee Surgery increasingly perform hip and knee relacements in older patients.  We take great care to assess fitness for surgery and to plan surgery and subsequent discharge either to the patients home or to a convalescence facility.  We have observed that these older patients do as well (and sometimes better!) than some of the younger patients.  The following study is, therefore, of interest.

Hip and knee replacements are rarely performed in patients older than 100 years, according to a study published in the August issue of Arthritis and Rheumatism. However, these patients should not be denied the option of this surgery.

Dr. Eswar Krishnan, of the University of Pittsburgh, Pennsylvania, and colleagues point out that, from a doctors perspective, osteoarthritis and osteoporotic hip fracture are “two major causes of disability among the older age group.”

The researchers examined the epidemiology and mortality outcomes of joint relacement among centenarians. They used data from the Health-care Cost and Utilization Project Nationwide Inpatient Sample for the years 1993 through 2002. Nonagenarians were used as a comparison group.

A total of 679 hip relacements were identified among centenarians, compared with 33,975 among nonagenarians. There were only 7 knee replacements among centenarians, and 2,050 among nonagenarians. Eighty-three percent of centenarians who underwent joint replacement were women.

Hospitalization for hip replacement among those over the age of 100 was associated with a lower risk of complications  when the analyses were performed using records of all centenarians.

“The patients who get joint replacement do well in the short term,” Dr. Krishnan said in an interview with Reuters Health.

“Joint replacements for centenarians are likely to be more frequent in the future, when selectively performed joint replacements can improve functional status of many of the elderly patients,” Dr. Krishnan explained.

These findings suggest that joint replacements should not be denied to centenarians because of short-term post-operative life expectancy estimates, the researchers conclude.

Arthritis Rheum 2007;57:1038-1042

A number of patients have both hip pain due to arthritis and back pain.  Surgeons at The Centre for Hip & Knee Surgery, in common with other surgeons, tend to advise patients that after a total hip replacement, an improvement in their back symptoms often occurs (although they cannot guarantee this). 

This interesting study is the first to prove objectively that such an improvement does occur.

 Peleg Ben-Galim, MD,* Tal Ben-Galim, MD,^† Nahshon Rand, MD,^‡ Amir Haim, MD,* John Hipp, PhD,^§ Shmuel Dekel, MD, PhD,* Yizhar Floman, MD^‡

*Department of Orthopedic Surgery “B,” Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
^†Hadassah Medical School, Kiryat Hadassah, Jerusalem, Israel
^‡Israel Spine Center, Assuta Hospital, Tel-Aviv, Israel
^§Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX

Study Design: Prospective clinical study on the effect of total hip replacement surgery (THR) on low back pain (LBP) in patients with severe hip osteoarthritis.
Objective: To assess the effect of THR on LBP.
Summary of Background Data: Hip osteoarthritis causes abnormal gait (limp) and abnormal spinal  alignment and this is associated with LBP.
Methods: All consecutive adults scheduled for THR due to severe hip osteoarthritis were assessed by an independent investigator before surgery and 3 months and 2 years post-THR. The Harris Hip Score and the Oswestry Spine scores were used to evaluate hip- and spine-related symptoms, respectively, as were visual analogue scales (VAS) and spinal radiographs.

Conclusion: Both LBP and spinal function were improved following THR. This study demonstrates the clinical benefits of THR on back pain and is the first to clinically validate hip-spine syndrome as hypothesized by Offierski and MacNab in 1983

•  Vigorous physical activity benefits knee cartilage in patients without knee injury, and walking reduces the risk for bone marrow lesions in the knee, according to the results of a study reported in the September 28 Online First issue and will appear in the October 15 print issue of Arthritis & Rheumatism.
• Among 190 participants who reported regular walking, baseline regular walking was associated with protection against tibiofemoral bone marrow lesions.
• Regular walking was not associated with tibial cartilage volume loss or cartilage defects.
• Baseline physical activity associated with work or activity in the home was not associated with protection against cartilage defects or volume.
• The authors concluded that a level of vigorous physical activity of at least 20 minutes per episode per week resulting in sweating or shortness of breath in adults with no history of knee injury or arthritis has a protective effect on knee cartilage.
• They concluded that exercise that is good for the heart is not detrimental to the knee joint.