New research from Northwestern Medicine suggests that patients with knee osteoarthritis are having knee surgery at the wrong time.
According to the researchers, 90% of patients who could benefit from knee replacement surgery are waiting too long to have it and 25% of patients who don’t need it are having it prematurely.
“People are waiting and waiting to have the procedure and losing the most benefit,” lead investigator Hassan Ghomrawi said in a news release.
The study also found that African Americans delayed knee replacement surgery more than Caucasians.
“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.”
Delaying surgery can also result in less benefit, according to the researchers.
“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.
Ideal timing for knee replacement surgery is decided based on an algorithm that uses pain, joint function, radiographic assessment and age to determine if a patient will benefit from surgery.
If a patient gets surgery based on the algorithm, the researchers suggest that they are having major surgery with a risk of complications while getting little benefits. Too soon surgery also increases the risk of needing a revision later in life.
“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 healthcare 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 the timing of surgery.”
The study was published in the Journal of Bone and Joint Surgery and was funded by grants from the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health.