A new study released as part of the American Academy of Orthopedic Surgeon’s Virtual Education Experience showed that hip and knee replacements result in significant improvement in the quality of life not only for patients, but also for their spouses. The study is in the process of being peer-reviewed.
“It all started when one time I got a thank you note from a patient’s wife,” said lead author Michael Tanzer, an orthopedic surgeon and Jo Miller chair of orthopedic research at McGill University Health Center in Montréal, Québec. “His wife wrote a card thanking me for operating on her husband and giving back her life and what a dramatic change it had on her life and marriage."
Over 32.5 million U.S. adults are affected by osteoarthritis, which is the most common form of arthritis and occurs when the protective cartilage cushioning the ends of your bones wears away. It can result in heightened pain, reduced mobility and even depression. Joint replacement surgery typically results in significant improvements in functioning and emotional distress and pain.
"Doing joint replacement is extremely gratifying. I tell patients that this operation will turn your frown upside down," said Dr. Roy Davidovitch, associate professor of orthopedic surgery at NYU Langone, who was not involved in the study. "Hip replacement is considered one of the most successful procedures of all surgeries."
Very often spouses of people with osteoarthritis take on the role of caregiver, requiring them to make dramatic lifestyle adjustments. Caregivers indirectly experience the pain and distress of their partner’s osteoarthritis and can even perceive their partner’s pain to be higher than it actually is. Doctors say joint replacement surgery may ultimately improve the lives of both patient and spouse and in the process strengthen their marriage.
Researchers interviewed 33 couples, with the average age of the patients being 68 years old and 67 for their spouses. On average, couples had been married for about 36 years. Overall, patients said the most noticeable improvement in order of importance after their surgery was change in mobility, resuming pleasurable activities and less pain.
Spouses on the other hand prioritized the advantages of the surgery differently. Seventy percent reported that the main advantage of the surgery was the ability to carry on with social and leisurely activities with their partner, followed by no longer witnessing patient suffering, less burden to act as a caregiver and a greater sense of independence. Spouses also ranked their partner's pain level higher before and after the surgery than the patient's.
The study authors acknowledged that more research needs to be done with a larger and more diverse number of couples to understand why spouses and patients responded differently. But they believe this data will hold true even in a larger study and can help doctors to decide whether surgery is necessary.
“When we decide to do a hip or knee replacement it's a clinical decision. It’s not based on the X-ray. The X-ray tells us why it hurts, but doesn't tell how much it hurts,” Tanzer explained.
In deciding to operate, clinicians, along with the patients, should take into account more than just physical disabilities and also consider the dysfunction the patient's condition has placed on his or her personal and marital life.
Davidovitch said a patient's spouse or partner is typically good at providing a complete picture of the patient's functional level, which is important input in deciding whether or not to proceed with surgery.
According to Tanzer, “Disability isn't just your personal disability. It can also be your family or marital disability.”
"This study echoes what surgeons have noticed in the past -- the effect of joint replacement goes beyond increasing their range of motion and decreasing their pain," said Davidovitch. "It has a much greater psychosocial impact and not surprisingly impacts relationships."
Eden David, who studied neuroscience at Columbia University and is matriculating to Icahn School of Medicine at Mount Sinai later this year, is a member of the ABC News Medical Unit.