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Paul Dieppe, Rubén Ernesto Mújica Mota, When should we do joint replacements? Early or late?, Rheumatology, Volume 52, Issue 10, October 2013, Pages 1737–1738, https://doi.org/10.1093/rheumatology/ket242
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Are data from the West applicable to the developing world?
This editorial refers to Associations between preoperative functional status and functional outcomes of total joint replacement in the Dominican Republic, by Kyle E. Dempsey et al., on pages 1802–8.
The article by Dempsey et al. [1], published in this edition of Rheumatology, is the first to document the relationship between preoperative functional status and outcomes after joint replacement in a developing country. Their data showed that patients in the Dominican Republic undergoing hip or knee joint replacement improved greatly, and had similar good outcomes after 1 year, irrespective of the severity of the disease at the time of surgery. This finding differs markedly from that of numerous similar studies undertaken in developed countries, which have consistently shown that patients who are severely functionally compromised at the time of surgery do not end up as well as those with less severe disease [2, 3]. We have illustrated comparative data about knee replacement patients from the study by Dempsey et al. (in the Dominican Republic) with data from developed countries brought together by Lingard et al. [4] in Fig. 1. Not only do the final outcomes in the Dominican sample seem unrelated to preoperative scores, but also patients undergoing surgery with the worst scores (lowest tertile) exceeded the outcomes of the healthiest patients from developed countries (WOMAC >57 group)—a remarkable result.
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