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While total joint arthroplasty (TJA) undoubtedly improves the lives of arthritis sufferers, the proportion of patients reporting good outcomes is significantly lower than the figures typically cited. This is according to researchers from Women´s College Hospital in Toronto, Canada, whose study aimed to determine which patients would experience the greatest benefits after TJA. The team is also hoping that the findings will provide valuable insight on the best time for surgery.

Led by Dr Gillian A. Hawker, the researchers studied 202 Canadians who assessed their pain and mobility before primary TJA and after their operation. Within that group, 133 patients had a knee replaced and 69 underwent hip replacement surgery. Most of the subjects (93%) had osteoarthritis (OA) and the remainder suffered from inflammatory arthritis. Around 83% reported at least two problematic joints, almost 57% listed persistent back pain among their health problems and over one-third were obese.

Following the surgery, 53.5% of the study subjects defined the outcome as good, which means clinically important improvement in pain and disability. The proportion typically cited is between 80% and 90%. According to Dr Hawker, the result obtained by her team makes sense. When people suffer from other health problems, replacing one joint does not eliminate all other problems. The relatively low proportion can also be explained by the strict criteria for a good outcome, as well as the exclusion of patients who had a second joint replaced.

The Canadian research team listed several factors of importance in achieving the best TJA results. These include high levels of pain before surgery, no more than one “troublesome” hip or knee, lack of other health problems and joint damage resulting from OA rather than inflammatory arthritis.