VANCOUVER, BC, Aug. 10, 2021 /CNW/ – New research has revealed a significant reduction in the need for total hip and knee replacement surgery among rheumatoid arthritis patients after the introduction of biologics.
“These findings reflect a marked improvement in overall rheumatoid arthritis treatment since the introduction of biologics in the early 2000s,” said Hui Xie, a scientist at Arthritis Research Canada.
Researchers identified 60,227 rheumatoid arthritis and 288,260 osteoarthritis cases. For individuals diagnosed before the introduction of biologics, the 8-year incidence rates of total joint replacement surgery increased over time for both types of arthritis. For people diagnosed after biologics became available, these rates decreased over time in rheumatoid arthritis but continued to increase for osteoarthritis.
“We found a 26.9 per cent and 12.6 per cent reduction in total hip and knee replacements for patients with rheumatoid arthritis diagnosed five years after the introduction of biologics, in stark contrast with 11.7 per cent and 16.6 per cent increases for those procedures in osteoarthritis over the same time period,” said Vivienne Zhou, the first author of the paper and an MSc student trainee at Arthritis Research Canada.
Osteoarthritis is another condition for which total joint replacements are often required, and for which biologics are not used. This made osteoarthritis an ideal comparator group that had not been used in previous studies.
Rheumatoid arthritis, the most common type of inflammatory arthritis, affects approximately 1.2 per cent of Canadians aged 16 years and older. Uncontrolled inflammation causes irreversible joint damage which sometimes requires total joint replacement surgery.
Total joint replacements are effective at reducing pain and improving function, but they are expensive and complications can occur. Sometimes revision surgeries are also needed.
From 2019 to 2020, 63,496 hip replacements and 75,073 knee replacements were performed in Canada, costing more than $1.4 billion, according to the Canadian Institute for Health Information.
Biologics, such as tumor necrosis factor alpha inhibitors (TNF-α), are very effective at suppressing inflammation and can halt the progression of rheumatoid arthritis and prevent joint damage.
Prior to this study, there was conflicting evidence as to whether or not biologics reduced the need for total joint replacement surgery in rheumatoid arthritis patients. This study uses large population-based cohorts of incident rheumatoid arthritis and osteoarthritis patients to document and compare the patterns of total joint replacement surgery over a 20-year period.
ABOUT ARTHRITIS RESEARCH CANADA:
Arthritis Research Canada is the largest clinical arthritis research institution in North America. Our mission is to transform the lives of people living with arthritis through research and engagement. Arthritis Research Canada’s scientific director, Dr. Diane Lacaille is leading a team of over 100 researchers, trainees and staff whose world recognized research is creating a future where people living with arthritis are empowered to triumph over pain and disability. Arthritis Research Canada is conducting research across Canada in British Columbia, Alberta and Quebec and is affiliated with five major universities: University of British Columbia, Simon Fraser University, University of Calgary, Université Laval, and McGill University. Arthritis Research Canada is leading research aimed at arthritis prevention, early diagnosis, new and better treatment, and improved quality of life.
SOURCE Arthritis Research Canada
For further information: or to arrange an interview, please contact: Heather Caulder, Marketing and Communications Officer, 604-207-4010 or [email protected], www.arthritisresearch.ca
Originally Appeared Here
If you will soon need to recover after hip replacement surgery, or any major surgery involving your hip, you should carefully research what will happen, and how to cope, both before and after the operation. How should you prepare for hip surgery? What is recuperation from hip surgery look like? Will you need help after a hip operation? How soon can you return to work or resume normal daily activities?
Your orthopedic surgeon and medical team are the best authorities for specific answers related to your particular health, hip condition, work situation et cetera. The questions below, however, address some common questions and shares tips about hip replacement recovery and rehabilitation.
How can I prepare for hip replacement surgery?
A few health habits can be implemented in advance to ensure a quick and smooth recovery from hip surgery. You can help ensure a smooth and quick recovery if you are considering a hip replacement.
It is a smart idea to build your strength. Stronger upper bodies will make it easier to use crutches and a walker.
After surgery, your mobility and ability for daily activities will be severely reduced. Discuss the need for support after surgery with your loved ones, friends, and caregivers. Make practical changes to your home to ensure that you have easy access to the things that you require.
Safety is also important. Move furniture or remove rugs that make it difficult for you to use crutches/walkers.
What is the best time to return home after a hip-replacement?
Typically, hip surgery patients can walk and go home within a few days. Most people do not need to be bed-bound. Moving your joint can prevent it from becoming stiff.
You might have to stay the night in hospital if you have a preexisting condition, such as a heart condition or lung condition that requires monitoring. Inpatient rehabilitation units are a good option for people who have had complicated surgeries and need support at home.
Do I have to learn how to walk again – what equipment may I need?
Your medical team – including your orthopedic surgeon, physical or occupational therapists, and primary care doctor – will assess whether you need any assistive devices. If you have fallen or that seems likely, you may need a cane, or a walker. However generally not necessary to keep weight off the hip that went through surgery.
How soon will my hip incision heal?
Modern hip replacement surgery incisions are small and closed with absorbable stitches. It takes approximately six weeks for the incision to heal. It is okay to shower during this period, but it is best to wait until the wound heals completely to bathe or swim.
What is the time frame for rehabilitation after hip surgery?
Before the hip replacement surgery, patients will receive physical therapy. Then they will work with a physical trainer right after the surgery to learn and practice muscle strengthening exercises. The rehabilitation process will continue for a few more days following the surgery. Patients will see occupational and physical therapists up to three times per week, and are given exercises to do at home as well.
The first step in rehabilitation is to get used to your daily movements. Next, you will need to practice more difficult tasks like climbing stairs or getting in and out of your car.
These and other tasks are possible only if you have strong muscles. Rehabilitation includes resistance training for the hip muscles and the knee muscles in your legs.
What is the “normal” level of pain following hip replacement surgery?
After hip replacement, there will be some swelling and pain in the joints. This will help to reduce the pain.
- Between therapy sessions, take some time to relax. Ice the leg and the site of your incision.
- Consider taking anti-inflammatory medications, with your doctor’s okay, to help with these symptoms.
- When you lie down, keep your leg higher than your heart.
- Pay attention to your pain levels.
- If your pain levels are at 6 or above (on a 1-10 pain scale), be sure to mention this to your surgeon or primary care doctor. Your pain should gradually decrease as you continue physical therapy.
How long does it take for your hip to heal after a hip replacement surgery?
The average time for hip replacement recovery is between two and four weeks. However, everyone is different. It all depends on several factors such as how active you were prior to surgery, your age and nutrition.
Being active and in good shape before surgery can make it easier to recover faster and return to your usual activities. Prehabilitation (or prehab) is a term used by physical therapists and orthopedic surgeons to help patients become physically fit before they undergo surgery.
What is the best time to resume my regular activities following a hip replacement surgery?
Physical therapy’s goal is to help you get back to your daily life. The amount of physical activity required to complete a task will determine the time it takes to accomplish that task.
Driving: It may take up to one month for you to be able again to drive safely after having surgery on your right hip. You might be able to drive again in a matter of weeks if it was your left hip. You can start in a parking lot, then move slowly to rural roads and eventually to the highway. You might not be able to drive again if you are taking medications that can impair coordination.
Work: You can return to work in two weeks if you have a desk job that requires little activity. It is recommended that you take off six weeks for any job that requires heavy lifting, or is otherwise difficult on your hips.
Sports: You can return to sports that require little activity like golf when you feel at ease. You should wait six weeks for contact sports that have high-impact. You should wait six weeks for the incision to heal completely before you can get into a pool.
Sex: You can go back to sexual activity at any time you feel like it, as long as you can do so comfortably.
What factors slow recovery from hip surgery?
There are always complications with any surgery, even major ones like a hip replacement. These complications can include infection at the incision, bone fractures, and hip dislocations.
Contact your doctor immediately if you experience severe pain, such as fever, swelling, or difficulty moving your hips, or if your medication isn’t working.
Rehab should be done at a steady pace. Avoiding sudden movements and sharp movements may help to prevent falls and dislocations that can delay recovery.
How long can my hip replacement implant last before it needs to be replaced?
Modern hip prosthetics, unlike older metal implants, are made from a mixture of metal, plastic, and ceramic parts. They are stronger and more resistant than older ones. These implants are durable and can last for up to 30 years. There is little chance of them failing or needing to be re-done.
What is the best time to wait before I replace my other hip?
There are some cases where it is beneficial to replace both hips simultaneously (a double-hip replacement). A double hip replacement may be safer for those with severe arthritis in both of their hips.
A double hip replacement decreases the chance of complications associated with anesthesia. The recovery process is quicker but can take twice as long because both legs must be strengthened simultaneously. You might also find it more difficult to move around the house at first, so you may need more help at home.
To reduce the risk of blood clots, it is better to wait at most six weeks before having two hip replacements.
The hip replacement procedure is one of most successful in medicine. The effectiveness of total hip replacement surgery has increased dramatically since the 1960s thanks to improvements in joint replacement technology and surgical techniques. The American Academy of Orthopaedic Surgeons reports that more than 450,000 total hip repairs are performed annually in the United States.
If you’re worrying about how to prepare your home before hip or knee surgery, this article should help you enormously.
First important tip: set up your home BEFORE you go to the hospital. This will make it easier for you to recover and to live in comfort when you return. This should be done well in advance.
Ask your doctor or physical therapist to get your home ready.
Advance Home Preparation Makes It Easier
Make sure that everything is easily accessible and on the main floor (or wherever you spend most of your time.) Limit the amount of stairs you use per day to one.
- A bed should be low enough that your feet touch the ground when you are seated on the edge.
- If possible, place your bed on the main/first floor. Although you don’t necessarily need a hospital bed for your comfort, your mattress should be firm.
- You should have a toilet or portable commode located on the same floor as where you spend most of your time.
- You can stock up on canned and frozen food, toilet paper and shampoo.
- Buy or make single meals that can be frozen then reheated.
- You should be able to reach all the things you need without bending or getting on your knees.
- Place food and other supplies in a cabinet that is at your waistline and shoulders.
- Place glasses, teapots, and any other items that you use often on the kitchen countertop.
- You must be able to reach your phone. You can use a portable phone to get around.
- In the kitchen, bedroom, bathroom and any other areas you use, place a sturdy chair. You will be able to sit comfortably while you complete your daily tasks.
- Attach a bag or small basket if you plan to use a walker. You can keep your phone, notepad, pen and other essential items in the bag. A fanny pack can also be used.
It is possible that you will need assistance with bathing, toilet use, cooking, shopping, going to doctor visits, exercising, and even running errands. Ask your provider to send a caregiver to your home if you don’t have anyone to help you for the first few weeks following surgery. This caregiver can help with daily activities and check on the safety of your home.
You might also be interested in these other items:
(Amazon has a Hip – Knee Replacement Kit that may be of interest.)
Bathroom Setup for Easier Use After Knee or Hip Surgery
You can reduce your knee flexion by raising the height of the toilet seat. This can be done by installing a seat cover, an elevated toilet seat, or a safety frame for the toilet. A commode chair can be used in place of a toilet.
Safety bars may be required in your bathroom. Grab bars should be attached vertically or horizontally to a wall, and not diagonally.
- Towel racks should not be used as grab bars. They will not support your weight.
- Two grab bars are required. The first helps you to get in and out the tub. The other assists you in standing from a sitting position.
There are many ways to make sure you’re safe when you take a shower or bath.
- To prevent falls, place non-slip silicone decals or rubber suction mats in the tub.
- For firm footing, use a non-skid bathmat outside the tub.
- Dry the floors outside of the bathtub or shower.
- You can place soap and shampoo anywhere you don’t need to stand, reach, or twist.
Take a shower in a chair or a bathtub.
- Rubber tips are recommended for the bottom.
- If the seat is to be placed in a tub, you can buy a chair without arms.
Avoiding Falls and Tripping In Your Home After Surgery
Avoid tripping hazards in your home.
- To move from one room to the next, remove any wires and cords.
- Take out any throw rugs that are not in use.
- Doorways with uneven flooring should be repaired. Use good lighting.
- Install night lights in darkened rooms and hallways.
You may trip if your pet is small or moves around a lot. Consider letting your pet live with a friend or in a kennel for the first few weeks of your stay.
When you’re walking, don’t carry any items. Your hands may be required to balance. To carry your phone and other items, a small backpack is a good option.
You can practice using a walker, crutches or a wheelchair. It is important to learn how to:
- You can get in and out of a seat easily
- After using the toilet, sit down and then stand up.
- Shower in the morning and get out at night
- The shower chair can be used
- Stairs can be used to ascend and descend
Is it possible to prevent hip surgery or replacement altogether?
Sixty-five-year-old Ian Lovatt is waiting for a hip replacement, but cannot be operated on. As a result, he has been tied to the house for two years.
“Can you imagine a broken glass in your hip? That’s what it feels like every time you take a step or move.”
Hawke’s Bay DHB admits he needs surgery, but told him others had priority. He has been denied time and time again.
“Annoying, sad. It’s actually very depressing. I feel like a prisoner because I’m just trapped. I can’t get out.”
Lovatt carries morphine for 18 months and is worried about his addiction, so he manages the amount he takes.
“I try to reduce morphine, so I don’t trust it all the time, but you depend on it because the pain gets worse.”
The DHB says there is a greater demand for elective surgeries and is working hard to meet it by building an eighth operating room and collaborating with a private hospital.
But Dr. Darran Lowes, a local GP, worries that DHB is out of date.
“Over time it has gotten worse and now the threshold for entering the surgical waiting list is extremely high,” he says.
“We just don’t have enough beds, enough theaters, enough services to do that.”
It is a similar situation in Northland. Margaret Pohl is the clinical director of orthopedic surgery at Northland DHB and has seen a growing wave of people in need of joint surgery.
She says there isn’t enough operating room space for elective surgeries, and a lot of people don’t even get on the waiting list.
“We’re setting aside about 50 percent of people referred to joint replacement surgery,” he says.
“Year after year it has gotten worse and the hardest thing for all surgeons are the patients they have rejected.”
The number of people operated on for joint surgery has increased. Figures from the Ministry of Health show that during the nine months to March 2019, 7524 people underwent joint replacement surgery. And in the nine months to March 2021, there were 8007 people.
But the number of people on waiting lists has also grown: from 3,881 people in March 2019 to 5,407 people in March this year.
The ministry attributes some of this to the backlog of COVID-19, but Dr. Lowes argues it has long been a problem.
“The population here is aging and with it the demand for surgery is increasing.”
As a result, he sees that more morphine is prescribed to relieve pain.
The amount of publicly funded morphine prescription dispensed between 2016 and 2020 increased by approximately 22,500, from 511,896 to 534,389.
Most are for young people aged 60 to 69, an increase of 12,473.
Dr. Lowes is worried about people getting addicted to it.
“We certainly see tolerance and dependence a few days after starting it, so it’s a big problem.”
Stu Desmond of Kaitaia is another who takes morphine to deal with pain.
“You try not to cry, it gets pretty exciting,” he says.
He is awaiting hip surgery and is aware that the drug is addictive.
“I’m lucky to be able to limit myself to two or three a day.”
But not everyone is lucky that Desmond and some end up being addicted.
“We’re seeing an increasing amount of pain and an increasing use of drugs to control their pain,” Dr. Pohl says.
In last year’s budget, the Government injected $ 282 million into DHBs to help eliminate a backlog of elective surgeries, caused in part by COVID-19.
Health Minister Andrew Little is aware of the problem.
“We know there are long waiting lists and we know people are struggling to get on the waiting lists,” he says.
“It bothers me that people are being given morphine to relieve pain because there is no end. That’s not good enough.”
He hopes the health care reform, which scratches the structure of DHB, will also help.
“We should be able to divert people to where the capacity is available.”
He can’t get there soon enough for Lovatt.
“All I want is to get it, get back to normal.”
We return to a life without constant pain and without morphine.