Study Suggests Patients May Live Longer After THA
Total hip arthroplasty (THA) not only improves quality of life, but it also is associated with increased life expectancy, according to a study published in Clinical Orthopaedics and Related Research.
Peter Cnudde, MD, of the Swedish Hip Arthroplasty Register, Gothenburg, and his colleagues found that through a decade after surgery, patients undergoing elective THA have a slightly higher survival rate than the general population. “Our study suggests that hip replacement can add years to life as well as adding ‘life to years’ – increasing the chances of longer survival as well as improving the quality of life,” Dr. Cnudde said.
He and his colleagues analyzed postoperative survival rate in nearly 132,000 patients who underwent THA in Sweden from 1999 through 2012. Average age at surgery was 68 years. During a median follow-up of 5.6 years, 16.5% of patients died.
Survival after THA was longer than expected, compared with people of similar age and sex in the Swedish general population. In the first year, survival was 1% better in THA patients versus the matched population.
The difference increased to 3% at 5 years, then decreased to 2% at 10 years. By 12 years, survival was no longer different for THA patients versus the general population.
The survival difference was significant mainly among the 91% of patients diagnosed with primary osteoarthritis. In patients with certain other diagnoses – including osteonecrosis, inflammatory arthritis, and “secondary” osteoarthritis due to other health conditions or risk factors – survival after THA was lower compared to the general population.
Not surprisingly, patients with more comorbidities had lower survival after THA. Lower education and single marital status were also associated with lower survival.
Total hip arthroplasty has a proven track record in increasing mobility, reducing pain, and improving quality of life in people with hip pain and dysfunction. The researchers note “strong indications” that patients’ survival after THA is improving, and that patients undergoing THA tend to live longer than a matched general population. The new findings support that impression, showing a small but significant improvement in expected survival in patients undergoing THA.
“The reasons for the increase in relative survival are unknown but are probably multifactorial,” the researchers write. They note some important limitations of their registry study, including the fact that that only patients in relatively good health are selected for THA.
“While no surgeon would recommend THA to the patients just to live longer, but it is likely that the chances of surviving longer are associated with undergoing the successful operation, for patients in need of a hip replacement,” Dr. Cnudde said. He noted that this could be proven only by a randomized controlled trial, but that type of study would be impossible to perform for ethical reasons. “So, data gathered by registers as part of a well-conducted observational study can provide these answers, in our opinion.”
Cnudde P, Rolfson O, Timperley A, et al. Do patients live longer after THA and is the relative survival diagnosis-specific? Clin Orthop Relat Res. Published online ahead of print, 28 Feb 2018. doi: 10.1007/s11999.0000000000000097