CORR Insights®: How Does Mortality Risk Change Over Time After Hip and Knee Arthroplasty?

摘要

Total hip and knee replacements are well-established, cost-effective surgical procedures that decrease pain, increase function and mobility, and improve the quality of life for patients with osteoarthritis (OA). Patients generally undergo thorough medical assessment and risk mitigation before surgery, so that the surgical procedure and aftercare can proceed as smoothly as possible. Patients who have extensive medical comorbidities that cannot be adequately improved upon often are not offered elective major surgery like arthroplasty. This selection bias may account for the decrease in mortality observed in patients undergoing total joint replacement (TJR), compared to a matched cohort not undergoing the operation during the first few years after surgery [ ]. However, less is known about the long-term effects on longevity after TJR of the lower extremity. Although mortality in the first few years after TJR has declined [ , , ], recent evidence from several centers in North America and Europe observed that mortality after about a decade increases [ , , ]. These findings seem counterintuitive; one presumes that healthier patients undergoing an operation for joint pain and limited function would subsequently become more active and enjoy the health benefits of a more vigorous lifestyle. Unfortunately, most patients who undergo joint replacement of the hip and knee do not increase their activity levels postoperatively [ ]. Furthermore, most patients do not lose excessive weight after TJR [ ]. These points are enormously important, as the Western population is aging, and increased numbers of joint replacements are being performed worldwide at substantial cost.