Psychological, Sexually and Social Consequences of Osteoarthritis Treatment With Total Hip or Total Knee Arthroplasties and Joint Preserving Surgery

In Denmark approximately 16.000 artificial hips or knees are inserted yearly. A increasing number that probably will continue to increase due to demographic factors and the populations rising demands on a active life in the old age. However of the 16.000 artificial joints approximately 10% are inserted in patients under fifty years(1;2). This group of patients is mid-life and thereby for most parts working and socially- and sexually active.

Total hip arthroplasty(THA) or total knee arthroplasty(TKA) is unquestionably one of the most successfully operations there has been introduced, and is capable of relieving pain, optimizing the function of the joint and optimizing the quality of life(3;4). In the resent years the main focus has been on optimizing the surgical track, whereby most of the patient today are only admitted to the hospital in 1-2 days. This progress has had a tremendous impact on patients, the departments and the health care system. Joint replacement surgery with THA or TKA is a key event for the patient and can recreate the patient's mobility but as well has widespread (but still undocumented) consequences for the patient and his future life.

In the preoperative treatment and planning of the correct time of surgery, it is imported to know, how the patient is affected of a disabling joint disease like end-stage osteoarthritis(OA) and which consequences it has to the patient to have an artificial joint. It is known, that patients with OA has a two-fold increased risk of depression(8-13).

These aspects of the treatment has so far not had the desirable attention, neither national or international At Hvidovre Hospital, Frederiksberg Hospital and Køge Hospital the Orthopaedic departments has many years of experience with joint replacement surgery at specialist level. The structures of the departments are based on modern fast-track principals, with clearly defined goals for preoperative information, pre- and postoperative regimes and discharged criteria. Thereby insuring a smooth course, short rekonvalens and a minimizing of complications.

Because of the limited lifetime for an artificial hip or knee, this treatment can be unfortunate for the young patient. This has over the last years led to an increased interest for joint preserving surgery. Over the last twenty years it has been tried to delay the time for total hip arthroplasties for patients with hip dysplasia with the aid of Peri Acetabular Osteotomy(PAO). Hip dysplasia is seen equally in both sexes. However it is more often symptomatic in females(14). In Denmark PAO is performed at Copenhagen University Hospital, Odense University Hospital and Aarhus University Hospital. The procedure is preformed on symptomatic (mainly sharp groin pain) patients in hope of delaying the development of OA. Femoroacetabular impingement (FAI) is believed to be the pathology, where repeated trauma to the acetabular labrum and adjacent chondral structures can result in labral tears and chondral delamination, leading to groin pain and over time OA. However there are only a few minor studies concerning which impact this procedure has on the young patients life in term of psychological, sexually and social wellbeing.