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There is overwhelming evidence that patients report marked improvement in function after joint replacement

24 October 2016

Responding to media reports that hip replacement procedures fail to make patients more active, NJR medical director Mr Martyn Porter said: 

“Joint replacement surgery offers significant benefits – getting patients back to their chosen lifestyle sooner, free from pain and with improved mobility. Of 91,760 patients surveyed in 2013, 92% described themselves as being either ‘excellent’, ‘very good’ or ‘good’ six months after surgery*.

“The main reason for doing hip replacement is to improve pain and there is overwhelming evidence that hip replacement is a wonderful success at improving pain dramatically for the vast majority of patients.

“The second reason for doing hip replacement is to improve function. Function can be measured objectively, for example, by getting a patient to do a test such as seeing how quickly they can walk up stairs, or subjectively, for example, by asking them how difficult it is to do certain tasks such as walking up stairs. There is overwhelming evidence(1) that patients report marked improvement in function after joint replacement.

“The message is that patients who undergo hip replacement have great relief of pain and report that doing everyday things, such as walking and dressing, are much easier after hip replacement. However, when we do tests in the first year after surgery, such as measuring how far patients can walk in 6 minutes after surgery compared to before, most studies do not show a marked improvement. 

“A possible explanation of patients reporting that they have excellent function, although objective measures still showing impairment, is that even though the tasks are still difficult in the first year after hip replacement, patients are not distressed by them because it no longer hurts.”

Commenting on the Withers et al study**, Professor Ashley Blom, head of statistical analysis for the National Joint Registry and head of orthopaedic surgery at the University of Bristol, said:

“Any suggestion that hip replacement does not work in the overwhelming majority of patients or is a waste of money is incredibly misleading and misrepresents the fine work done by Thomas Withers and team.

“We congratulate the Withers team on a well conducted study published in Clinical Rehabilitation. Their study examined previously published studies to see if there was published evidence of objective functional improvement within one year of hip replacement. They found that previous studies were not good at reporting objective outcomes of function, such as timed walk tests, and that those that did report these types of measures did not show strong evidence of improvement in these domains in the first year post-surgery.

“These findings agree with those of Stijn Bolink and team from the University of Bristol, which showed that after hip replacements subjective measures of function improve quickly, but objective measures more slowly.”

Notes to editors:

*      Hip replacement is a highly effective operation with a very high-level of patient satisfaction. Of 91,760 patients, 92% described themselves as being either ‘excellent’, ‘very good’ or ‘good’ six months after surgery. The EQ-5D index (a patient response to 5 questions about their health) over the same time period improved from a mean of 0.516 pre-op to 0.796 post-op. The Oxford Hip Scores improved from a mean of 18 pre-op to 41 post-op (ref. page 189, 10th NJR Annual Report 2013).  All these changes were highly statistically and clinically significant.  

Hip replacement was described as theoperation of the centuryin the Lancet in 2007 (here) and numerous other articles have confirmed the effectiveness and cost effectiveness of the operation:

**      The article, Is there a difference in physical activity levels in patients before and up to one year after unilateral total hip replacement? A systematic review and meta-analysis, by Withers et al suggests that physical activity may not improve within the first year of surgery although the low to moderate methodological quality of the included articles should be considered when drawing conclusions. Further research in this area is indicated. The reporting by The Sun that suggests “most hip replacement ops do more harm than good” is unhelpful to patients.

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