Arthritis

Updated 03 February 2016

Poorer patients often less happy with knee replacement

Inadequate post-op rehab might cause problems with knee replacement.

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Although knee-replacement  surgery has improved dramatically over the years - with smaller incisions and better pain management and rehabilitation - the procedure's success may depend on socioeconomic factors, new research finds.

Lower-income patients are more likely to be dissatisfied and have worse knee function than more affluent patients following knee-replacement, according to the study, which was published online recently in the journal Clinical Orthopaedics and Related Research.

Researchers led by Dr. Robert Barrack, of the Washington University School of Medicine in St Louis, examined more than 600 people who underwent knee-replacement surgery at one of five major total joint centres across the United States. The patients, whose average age was 54, were asked about their job, their level of education and their income. The study also took participants' gender and ethnicity into account.

Read: Study shows the value of alternative knee replacement treatment 

The patients completed questionnaires following their surgery to determine how satisfied they were with the results of the procedure.

Patients' income levels were linked to their level of satisfaction with their knee replacement, the study revealed. Those making less than R402.010 a year were less satisfied with the procedure and had more limitations with their knee function after surgery, according to a journal news release.

Income level was the only socioeconomic factor that affected patients' satisfaction with their knee replacement, the researchers said. Women and minority patients, however, were more likely to report having functional limitations after surgery.

Read: Smoking may cause knee pain

Inadequate post surgical rehabilitation for patients with lower incomes could help explain their findings, the researchers said. They noted that previous studies have shown that minority patients are more likely to be treated at hospitals that do not perform as many knee-replacement procedures as high-volume specialist centres, where overall satisfaction levels are high.

The researchers said the study did not find a cause-and-effect relationship between lower income and dissatisfaction with knee-replacement surgery, but said the association was "significant".

Read: Knee-replacement patients do just as well at home

"It is certainly possible, based on our results, that socioeconomic factors - particularly household income - may be strongly associated with satisfaction and functional results," they said.

"Future studies should be directed at determining the causes of this association, and if further studies do, in fact, confirm this hypothesis, then studies of clinical results after total knee [replacement] should consider stratifying patients by socioeconomic status."


Read more:

Future knee implants will be made by silkworms 

An MRI can spot the early signs of knee arthritis  

Knee replacement for those with rheumatoid arthritis

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Professor Asgar Ali Kalla completed his MBChB (Bachelor of Medicine and Bachelor of Surgery) degree in 1975 at the University of Cape Town and his FRCP in 2003 in London. Professor Ali Kalla is the Isaac Albow Chair of Rheumatology at the University of Cape Town and also the Head of Division of Rheumatology at Groote Schuur Hospital. He has participated in a number of clinical trials for rheumatology and is active in community outreach. Prof Ali Kalla is an expert in Arthritis for Health24.

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