The timing of knee replacement surgery is critical to optimize its benefit.
But in a new study, researchers found that 90% of patients with knee osteoarthritis who would potentially benefit from knee replacement are waiting too long to have it and getting less benefit.
In addition, about 25% of patients who don’t need it are having it prematurely when the benefit is minimal.
This is the first study to prospectively examine the timeliness of knee replacement among a large number of patients with knee osteoarthritis who could benefit from the surgery.
The research was conducted by a team at Northwestern Medicine.
Nearly 1 million knee replacement procedures are performed in the U.S. each year with projections of a rapid increase by 2030.
Few prior studies have quantified timeliness of surgery but only among patients who already had a knee replacement, and these studies generally were in smaller cohorts of patients.
The current study was based on 8,002 participants who had or were at risk for knee osteoarthritis and were followed for up to eight years.
The team says when people wait too long, two things happen.
The osteoarthritis causes deterioration of their function. Some of them wouldn’t be able to straighten out their legs, affecting their walking and mobility.
When you can’t get exercise, you can start to develop other health problems such as cardiovascular problems. You may also become depressed. The overall impact can be huge.
The second problem with delaying surgery is less benefit.
The ideal timing of knee replacement surgery is based on an algorithm that factors in pain, joint function, radiographic assessment and age to determine if a person will benefit from surgery.
Getting knee replacement surgery too early based on the algorithm means patients are having major surgery with risk of complications and getting the minimal benefit.
They may also need a revision (second surgery) later in life, which is a much more difficult surgery with poorer outcomes than the original surgery.
The lead author of the study is Hassan Ghomrawi, associate professor of surgery at Northwestern University Feinberg School of Medicine.
The study is published in the Journal of Bone and Joint Surgery.
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