For patients with symptomatic, radiographic, moderate-to-severe osteoarthritis or osteonecrosis of the hip or knee, total joint arthroplasty (TJA) should not be delayed in order to pursue additional nonoperative treatments, according to a clinical practice guideline issued by the American College of Rheumatology and the American Association of Hip and Knee Surgeons.
Susan M. Goodman, M.D., from the Hospital for Special Surgery in New York City, and colleagues conducted a review of the literature to develop recommendations for the optimal timing of hip and knee arthroplasty on patient outcomes, including pain, function, infection, hospitalization, and death at one year among people with symptomatic, radiographic, moderate-to-severe osteoarthritis or osteonecrosis of the hip or knee who have decided to undergo elective hip or knee arthroplasty after previously attempting nonoperative treatment.
The authors recommend a shared decision-making process between the physician and patient, considering the unique risks and benefits, in order to decide when to proceed with TJA. Conditional recommendations include not delaying TJA to pursue additional nonoperative treatments; delaying TJA to achieve nicotine cessation or reduction; delaying TJA to improve glycemic control among patients with diabetes mellitus; and not delaying surgery due to obesity but encouraging weight loss.
“There is no evidence that delaying surgery for any of the additional nonoperative treatments studied, including physical therapy, gait aids, oral anti-inflammatories, or injections, leads to improved outcomes, and may burden patients without clear benefit,” Goodman said in a statement.
