Patients with knee or hip osteoarthritis who became unwilling to undergo joint replacement after completing a 3-month education and exercise program were significantly less likely to have surgery in the following years, according to a large Swedish study.
The study included 55,059 adults with osteoarthritis who participated in a nationwide program offering disease education and personalized physical therapy. Before and after the program, participants were asked whether their joint symptoms were severe enough to make them want surgery. Based on their responses, they were grouped into four categories: always willing, always unwilling, became willing, or became unwilling to have surgery.
Five years after the program, those who shifted from willing to unwilling had a 20% lower risk of undergoing joint replacement compared with those who remained willing. Surgery was also delayed by an average of 1.1 years. At nine years, the likelihood of surgery remained 15% lower in this group.
“The hazard of having surgery at 1-year post-intervention was half that of those who were always willing,” the researchers wrote. By year five, the surgery rate among those who delayed the procedure began to converge with the always-willing group, likely because many of the latter had already undergone surgery earlier.
Most participants were women (69%), with a mean age of 66 years. Approximately 70% had knee osteoarthritis, and 30% had hip osteoarthritis. Ten percent of participants became unwilling to have surgery after the program, while 6% became willing.
Participants who became unwilling for surgery showed symptom improvement. Their average joint pain score decreased from 6.3 to 4.2 on a 0–10 scale. They were more likely to have knee osteoarthritis and reported fewer walking difficulties and higher quality of life than those who remained willing.
The effect was more pronounced in hip osteoarthritis. In this group, becoming unwilling to undergo surgery was associated with a 23% lower risk of receiving the procedure within five years. Among those with knee osteoarthritis, the reduction was 17%.
The authors noted that a single question about willingness for surgery could serve as a short- to medium-term indicator of whether patients will undergo joint replacement. While the study lacked a control group and cannot establish causation, it provides evidence that shifts in patient preferences following non-surgical interventions may influence surgical outcomes.
Further research is needed to explore how education and exercise affect willingness for surgery and how such changes can be maintained. The findings also highlight the value of including patient-reported outcomes in evaluating osteoarthritis treatment strategies.
Full disclosures are available in the study.
Source: PLOS Medicine