The replacement surgery may not be as successful as we think

A recent study (1) discussed the “increasing numbers of systematic reviews on total knee arthroplasty and total hip arthroplasty  (which) have been published in recent years, but their quality has been unclear.” What the researchers said were unclear were the study outcomes: “Clinicians should be judicious when applying the conclusions of the systematic reviews results to their own patients.” The surgery may not be as successful as we think.

Why some patients need to continue opioids six months after knee or hip replacement

In a July 2023 retrospective analysis of 10,140 consecutive patients (2) undergoing primary total hip replacement postponed total joint replacement revealed a higher 90-day revision rate, surgical complications, internal complications and transfusion rate than on-time total joint replacement. Delay in elective primary total joint replacement correlates with higher revision and complication rates.

Continued use of painkillers following surgery, in the case of the above study, for a minimum of three years after the surgery does give the appearance of a successful hip replacement surgery.

Balance Remains Impaired after Hip Replacement

A March 2022 study (3) examined the hoped for positive effects of hip replacement on patient balance.  Overall, the evidence found suggested that balance is impaired immediately after surgery and, 4-12 months after surgery, it becomes better than preoperatively, although without reaching the level of healthy subjects. A strong level of evidence was found for hip resurfacing resulting in better balance restoration than total hip replacement, and for strength and ROM exercises after surgery positively influencing balance.

Do patients have side-effects or do they think they have side-effects.

A 2020 study (4) suggested that people who report side-effects after their hip replacement surgery or prone to have worse surgical outcomes. That is not the point of this study. This suggestion is is that patients who report side effects have worse outcomes whether they actually have side-effects that can be confirmed by standard medical record review methods or they think they are having side-effects. “The observed negative trends suggest that patient perception of adverse effects may influence patient outcome in a similar way to those with confirmed adverse effects.” In other words if you are not happy with the surgery, you will have a bad follow up.

The gluteus medius tendon and weakened muscles

A December 2024 study (5) wrote that while patient satisfaction is high and functional ability improves after total hip replacement, residual impairment and pain are common. Degenerative changes in tendons and muscles are probable causes. The researchers suggest degeneration in the gluteus medius tendon and muscle strength in the muscles acting around the hip in patients with hip osteoarthritis, before and after total hip replacement is occurring. Pre and post-surgery muscle strengthening exercises should be explored.

1 Wu X, Sun H, Zhou X, Wang J, Li J. Quality assessment of systematic reviews on total hip or knee arthroplasty using mod-AMSTAR. BMC medical research methodology. 2018 Dec;18:1-0.
2 Holzapfel DE, Meyer M, Thieme M, Pagano S, von Kunow F, Weber M. Delay of total joint replacement is associated with a higher 90-day revision rate and increased postoperative complications. Archives of Orthopaedic and Trauma Surgery. 2023 Jul;143(7):3957-64.
3 Di Laura Frattura G, Bordoni V, Feltri P, Fusco A, Candrian C, Filardo G. Balance remains impaired after hip arthroplasty: a systematic review and best evidence synthesis. Diagnostics. 2022 Mar 11;12(3):684.
4 Carpenter CV, Wylde V, Moore AJ, Sayers A, Blom AW, Whitehouse MR. Perceived occurrence of an adverse event affects patient-reported outcomes after total hip replacement. BMC Musculoskeletal Disorders. 2020 Dec;21:1-8.
5 Juhlin J, Sernert N, Åhlund K. Pre-operative gluteus medius tendon degeneration and its impact on strength and functional ability one year after total hip replacement. Annals of Medicine. 2024 Dec 31;56(1):2388701.