NEW YORK (Reuters Health) - Waiting too long to replace hips and knees debilitated by arthritis might hurt patients' chances of improving after surgery, new research suggests.

A study of 340 patients with severe arthritis found that those who were in worse shape before their hip or knee replacements were significantly less likely to be enjoying good health a year after surgery.

Osteoarthritis, the form of arthritis usually associated with aging, is marked by the gradual breakdown of cartilage in the joints, leading to inflammation, swelling and pain. When conservative treatments like anti-inflammatory medication no longer help, surgery--including total replacement of the joint--may become necessary.

But the decision on when to go for surgery is left to the individual surgeon, and there is no clear "correct" timing for it, according to the authors of the new study.

To get a better idea of the role of timing, Dr. Carlos J. Lavernia and colleagues at the University of Miami School of Medicine in Florida compared patients who scored below-average on measures of hip and knee function with those who were relatively better-functioning before surgery.

The investigators found that among hip-replacement patients, those who were worse off before surgery continued to have more pain, less vitality and poorer overall health than other patients. Similarly, knee patients who started off in poorer shape continued to be less physically and socially active and have poorer psychological health--although patients who started out with more pain made greater improvements in this symptom, compared with their more-healthy counterparts.

According to Lavernia's team, this suggests that when it comes to knee-replacement surgery, the joint's functioning--rather than pain--may be a better predictor of how a patient will fare after the procedure.

They note that in 2000, the last year of this study, US managed care plans were not covering surgery for arthritis patients who had not undergone more conservative treatment for at least 2 to 3 months.

But, the authors argue, allowing patients with severe arthritis to reach the "lowest level" before surgery is attempted may hinder their recovery.

The study findings were presented recently in Dallas, Texas, at the annual meeting of the American Academy of Orthopaedic Surgeons.

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