High risk of revision surgery in younger joint replacement patients

Middle-aged people contemplating joint replacement for their arthritis should be warned of a high risk  — as much as one in three — of needing revision surgery within the decade, say UK researchers.

Their large, retrospective study of nearly 120,000 people undergoing hip or knee arthroplasty found relatively low rates of implant revision in patients aged over 70 — around 5% with up to 20 years of follow-up.

But for younger patients, it was a different story, with revision rates rising steadily as age decreased.

Sixty-year-old patients had a 15% lifetime risk of implant revision, while for those in their early 50s, the risk rose to 29% after hip arthroplasty and 35% after knee arthroplasty.

Related: Dos and don’ts before total knee replacement

There were large differences between genders, with men in their 50s having a 15% greater risk of revision than women in the same age category.

Time to revision peaked at around five years after the initial surgery, with more than half of revisions happening within six years.

The authors said that until now, revision rate data had been only from older patients and their study was the first to more accurately predict risk in younger people.

“Young patients are likely to spend many more years than previously expected with a revision implant, which carries with it poor outcomes”, the researchers from the University of Oxford wrote in the Lancet.

In a linked commentary, two Dutch orthopaedic surgeons noted a worldwide trend towards hip and knee arthroplasties in ever younger patients, with the strongest increase in patients aged 45-55.

In younger age groups, surgery tended to be more complicated, because many patients had congenital, developmental or traumatic abnormalities causing early osteoarthritis, they wrote.

The current trend to implant new hips and knees in younger patients was driven by the fact that outcomes in the first few years tended to be acceptable.

But increasing complications in many of these patients could mean that revision surgery was no longer viable, leading to permanent disability.

“Both patients and surgeons need to be aware of this possibility, and postponing this kind of surgery, despite the realistic limitations of patients with osteoarthritis, should be considered more frequently,” they wrote.

More information:

Lancet 2017; online.

Lancet 2017; online (editorial).

Source : http://www.australiandoctor.com.au/news/latest-news/beware-joint-replacement-in-younger-patients