Millions of people undergo hip and joint replacements each year and while surgery is intended to alleviate pain and restore function to the joints, an alarming new study shows one in five people awaiting a hip replacement experience pain they describe as “worse than death”. With 19 per cent of all people awaiting hip replacements reporting extreme pain and discomfort, researchers from the University of Edinburgh also found that as many as 12 per cent of patients on waiting lists for knee replacements find themselves in a similar state of health.
Many people believe hip and knee arthritis only causes mild discomfort and that surgery is optional, but researchers say the new findings disprove this incorrect perception. The study, published on Thursday in the Bone and Joint Journal, measured more than 4,000 Scottish patients’ health conditions by using an internationally approved score called EQ-5D for the first time in a study. EQ-5D measures the health-related quality of life and can be used for a variety of health issues and treatments.
Researchers used the rating to measure each patient’s ability to perform routine activities and look after themselves, while also recording their levels of mobility, discomfort and anxiety. The study measured the health states of more than 2,000 people waiting for a total hip replacement and found that 19 per cent were in extreme pain or discomfort, which the EQ-5D system defined as “worse than death”.
The study also found that people suffering other chronic health conditions including diabetes, heart failure and lung disease report high levels of pain while awaiting treatment, but that the scores specifically for joint replacement improved dramatically after patients underwent their surgery.
And, while hip and knee replacements are highly cost-effective and can result in immediate benefit from pain and disability, these types of surgery are typically limited or cancelled by health professionals because they’re not often considered as serious as other surgical procedures.
“Patients with the most extreme EQ-5D scores should be a priority for health care delivery,” study author Chloe Scott said in a statement. “Indeed, given the overall high levels of pain and disability described by all patients awaiting joint replacement compared with most other illnesses, access to appropriate treatment should be free and available to all at the time of need not limited by cost or bed availability.”
During a total hip replacement, damaged areas of the bone are removed by an expert and replaced by a prosthesis that can be made of ceramic, plastic or metal. The surgery itself can take up to two hours and within three months, most people can return to their normal activities and may even be able to complete tasks they couldn’t because of their hip pain.
Total hip replacements are considered elective surgery in Australia, with data from the Australian Institute of Health and Welfare (AIHW) showing that osteoarthritis is the most common condition leading to hip and knee replacement surgeries in the country. Between 2015 and 2016, 50,600 knee replacements and 30,900 hip replacements were performed in hospitalisations with a principal diagnosis of osteoarthritis, which is equal to 181 per 100,000 people for knee replacements and 112 per 100,000 for hip replacements.
Meanwhile, AIHW’s Elective Surgery Waiting Times 2017–18 report shows the median wait time for elective surgery has risen since from 36 days in 2013 and 2014 to an average of 40 days in 2017 and 2018. Of course, waiting times varied between states and territories, with times averaging 23 in the Northern Territory and 55 in New South Wales.
The proportion of patients having to wait more than a year to be admitted for their procedure also increased from 1.7 per cent in 2016-17 to 1.8 per cent in 2017-18.
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