Study: People Who Are Socially Isolated Experience More Pain After Hip Replacement Study 2013
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 Hospital for Special Surgery
Founded in 1863, Hospital for Special Surgery (HSS) is a world leader
in orthopedics, rheumatology and rehabilitation. HSS is nationally ranked No. 1
in orthopedics, No. 4 in rheumatology, and No. 5 in geriatrics by U.S.News &
World Report (2013-14), and is the first hospital in New York State to
receive Magnet Recognition for Excellence in Nursing Service from the American
Nurses Credentialing Center three consecutive times. HSS has one of the lowest
infection rates in the country. From 2007 to 2012, HSS has been a recipient of
the HealthGrades Joint Replacement Excellence Award. HSS is a member of the
NewYork-Presbyterian Healthcare System and an affiliate of Weill Cornell Medical
College and as such all Hospital for Special Surgery medical staff are faculty
of Weill Cornell. The hospital’s research division is internationally recognized
as a leader in the investigation of musculoskeletal and autoimmune diseases.
Hospital for Special Surgery is located in New York City and online at
www.hss.edu.