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When surgery is delayed, people don’t get full benefit
of new knee
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When surgery is premature, patients assume unnecessary
risk and may need a second replacement
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Nearly 1 million knee replacement procedures are
performed in the U.S. each year
The timing of knee replacement
surgery is critical to optimize its benefit. But 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, reports a new Northwestern Medicine study.
This is believed to be 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.
Few prior studies have quantified timeliness of surgery but only among patients
who already had knee replacement, and these studies generally were in smaller
cohorts of patients.
“People are waiting and waiting to
have the procedure and losing the most benefit,” said lead investigator Hassan
Ghomrawi, associate professor of surgery at Northwestern University Feinberg
School of Medicine.
African-Americans delayed knee
replacement surgery more than Caucasians, the study found.
“When people wait too long, two
things happen,” Ghomrawi said. “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. “You don’t get as much function back when you wait too
long; your mobility is still reduced versus somebody who had it in a timely
fashion,” Ghomrawi said.
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 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 study
will be published in the Journal of Bone and Joint
Surgery.
Nearly 1 million knee replacement
procedures are performed in the U.S. each year with projections of a rapid
increase by 2030, the paper reports.
“As the number of surgeries rises,
we need to make sure the timing is optimal for patients to obtain the most
benefit and to keep health care costs down,” Ghomrawi said. “Because knee
replacement is an elective procedure, the timing of surgery is susceptible to
not just clinical factors but also demographic, socioeconomic and sociocultural
ones. We need to develop a better understanding of these factors to improve
timing of surgery.”
The Northwestern study was based on
8,002 participants who had or were at risk for knee osteoarthritis and were
followed for up to eight years as part of two diverse multicenter trials, the
Osteoarthritis Initiative and Multicenter Osteoarthritis.
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