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Study: People Who Are Socially Isolated Experience More Pain After Hip Replacement

San Diego—October 29, 2013

Could being socially isolated affect how well you do and the amount of pain you experience after surgery? Researchers at Hospital for Special Surgery (HSS) set out to test this hypothesis. They found that people who lacked good social ties were much more likely to experience serious, ongoing pain following total hip replacement surgery two or more years after the procedure.

The study, titled “Social Networks and Hip Replacement Outcomes in Rheumatoid Arthritis and Osteoarthritis,” will be presented at the American College of Rheumatology/Association of Rheumatology Health Professionals Annual Meeting on October 29 in San Diego.

“Previous studies have shown that social isolation is a risk factor for poor health outcomes,” said Lisa Mandl, M.D., M.P.H., a rheumatologist at HSS who worked on this study with Danielle Ramsden-Stein, M.D., and colleagues at the hospital. “Studies show that people who don’t have good social ties are at increased risk of suffering a heart attack or stroke, and even dying, compared to those who enjoy the social support of family, friends and the community.”

HSS investigators found a strong association between how much pain OA patients continued to have after total hip replacement (THR) and the degree of social isolation they experienced. “About eight percent of the hip replacement patients were very socially isolated,” Dr. Mandl said. “There was a strong link between a lack of social interaction and increased pain.”

Socially isolated individuals were those with few close contacts—for example, not married, fewer than six friends or relatives, and no membership in either community groups or religious organizations.

For their study, investigators identified cases from a registry of more than 12,000 patients who had primary or revision hip replacement surgery from May 2007 to February 2011 for either osteoarthritis (OA) or rheumatoid arthritis (RA). Cases were validated via chart review to control for both expected differences between patient populations and time since surgery.

Researchers collected demographic information and evaluated patient pain and function using the Western Ontario and Universities Arthritis Index (WOMAC), both pre-operatively and between two and five years after surgery. The WOMAC is a widely-used questionnaire that assesses pain, stiffness and physical function.

In addition, the Berkman-Syme Social Network Index (BSSNI), which measures social integration, was administered between two and five years post-operatively. The BSSNI was divided into four categories, with the “most isolated” category being the referent group.

The survey was sent to 934 patients with a mean age of 62.  A total of 146/223 patients with RA (65.5 percent) and 541/711 patients with OA (76.1 percent) responded.  Demographics were similar in both groups. Both RA and OA patient groups had similar proportions of very socially isolated patients (8.2 percent and 7.8 percent respectively).

Investigators found that being socially isolated was associated with an almost three times increased risk of having “poor,” or severe, pain after THR, controlling for multiple potential confounding factors. “Poor” pain is defined as pain that is as severe as some patients had when they chose hip replacement surgery. In the study, social integration seemed more important for patients who had hip replacement for osteoarthritis, who comprise the vast majority of THR cases.

“We believe further prospective studies should be done to determine whether interventions to evaluate and improve patients’ social ties before surgery could lead to a better pain outcome  after hip replacement,” Dr. Mandl noted. “It could be a way to improve outcomes without medication or other costly interventions. I see no downside to helping patients get the social support they may need to improve their quality of life.”

 

About HSS | Hospital for Special Surgery
HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the ninth consecutive year) and No. 3 in rheumatology by U.S.News & World Report (2018-2019). Founded in 1863, the Hospital has one of the lowest infection rates in the country and was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center four consecutive times. The global standard total knee replacement was developed at HSS in 1969. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State. In 2017 HSS provided care to 135,000 patients and performed more than 32,000 surgical procedures. People from all 50 U.S. states and 80 countries travelled to receive care at HSS. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Global Innovation Institute was formed in 2016 to realize the potential of new drugs, therapeutics and devices. The culture of innovation is accelerating at HSS as 130 new idea submissions were made to the Global Innovation Institute in 2017 (almost 3x the submissions in 2015). The HSS Education Institute is the world’s leading provider of education on the topic on musculoskeletal health, with its online learning platform offering more than 600 courses to more than 21,000 medical professional members worldwide. Through HSS Global Ventures, the institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally.

 

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