What to weigh before choosing joint surgery

What to weigh before saying yes

Joint replacement may make more sense when soreness and stiffness greatly limit daily life. The exam must show that the worn joint is causing those limits. An X-ray can then show how much that joint has worn. Sleep, bathing, stairs, and walking matter more than one pain score.

Blood sugar, nicotine use, medicines, and help at home can affect recovery. Some concerns can be improved before an operation. Ask the surgeon which one matters in your case and why. You can also ask what needs to change before surgery.

When to get urgent help instead

Get prompt care when one joint becomes hot, red, and swollen. Feeling ill adds concern, though fever isn't always present with joint infection. Sudden weakness, numbness, deformity, or lost bladder or bowel control needs urgent help. After an injury, don't wait if you can't bear weight.

Fast changes need a different exam from long-lasting aches. Several swollen joints, a new rash, or weight loss also need attention. Tell the care team how quickly the problem changed. A visit booked ahead isn't right for symptoms that need immediate tests.

What to do if you are not ready for surgery

You may have useful non-surgical choices if basic care wasn't tried long enough. You may also want another view of the operation and recovery. Set a date to review walking, sleep, and other daily tasks. If they keep getting harder, return to the surgery talk.

If soreness remains, QC Kinetix discusses knee or hip surgery alternatives, including regenerative treatments that begin with your blood and go back inside the aching joint through a needle. A clinic medical provider performs the exam and the treatment. Before agreeing, ask whether the provider is a doctor, nurse practitioner, or physician assistant. Then ask what change would mean the treatment helped enough.

Sources

1. Applying a modified validated appropriateness classification to 205 Osteoarthritis Initiative patients who underwent total knee arthroplasty in the US, 44.0% (95% CI 37-51%) of the procedures were classified appropriate, 21.7% (95% CI 16-28%) inconclusive and 34.3% (95% CI 27-41%) inappropriate - approximately one third judged inappropriate, against about 20% in earlier studies outside the US.

   Riddle DL, Jiranek WA, Hayes CW. — Use of a validated algorithm to judge the appropriateness of total knee arthroplasty in the United States: a multicenter longitudinal cohort study.. Arthritis & Rheumatology, 2014. DOI: 10.1002/art.38685.

2. The 2023 ACR/AAHKS timing guideline conditionally recommends AGAINST delaying hip or knee arthroplasty to pursue additional non-operative treatment - physical therapy, NSAIDs, ambulatory aids or intra-articular injections - in patients with moderate-to-severe osteoarthritis for whom non-operative therapy has already been ineffective and who have chosen surgery. It conditionally recommends delay for nicotine cessation and for better glycemic control in diabetes, states that obesity by itself is not a reason for delay while weight loss should be strongly encouraged, and conditionally recommends against delay in patients with severe deformity or bone loss. Evidence for all recommendations was graded low or very low quality.

   Hannon CP, Goodman SM, Austin MS, et al. — 2023 American College of Rheumatology and American Association of Hip and Knee Surgeons Clinical Practice Guideline for the Optimal Timing of Elective Hip or Knee Arthroplasty for Patients With Symptomatic Moderate-to-Severe Osteoarthritis or Advanced Symptomatic Osteonecrosis With Secondary Arthritis for Whom Nonoperative Therapy Is Ineffective.. Arthritis & Rheumatology, 2023. DOI: 10.1002/art.42630.

3. In the only randomised controlled trial to compare total knee replacement directly with non-surgical treatment in patients already eligible for surgery (n=100), the replacement group improved more at 12 months than the non-surgical group (KOOS4 32.5 vs 16.0; adjusted mean difference 15.8, 95% CI 10.0 to 21.5) but had four times the serious adverse events (24 vs 6, P=0.005). Only 13 of 50 patients (26%) assigned to non-surgical treatment alone had undergone knee replacement by 12 months.

   Skou ST, Roos EM, Laursen MB, et al. — A Randomized, Controlled Trial of Total Knee Replacement.. New England Journal of Medicine, 2015. DOI: 10.1056/NEJMoa1505467.

4. Pooling the OAI and MOST cohorts (8,002 participants followed up to 8 years, 3,417 classifiable knees), validated appropriateness criteria classified only 290 knees (8%) as receiving a TIMELY total knee replacement, 2,833 knees (83%) as potentially appropriate but not replaced more than 2 years after replacement became appropriate, and 294 knees (9% of all knees, 26% of the 1,114 replacements actually performed) as PREMATURE. Of the potentially-appropriate-but-not-replaced knees, 1,204 (42.5%) had severe symptoms.

   Ghomrawi HMK, Mushlin AI, Kang R, et al. — Examining Timeliness of Total Knee Replacement Among Patients with Knee Osteoarthritis in the U.S.: Results from the OAI and MOST Longitudinal Cohorts.. Journal of Bone and Joint Surgery (American), 2020. DOI: 10.2106/JBJS.19.00432.

5. TOPKAT randomised 528 patients with medial compartment knee osteoarthritis across 27 NHS hospitals to partial (unicompartmental) or total knee replacement. At 5 years there was no significant difference in mean Oxford Knee Score (difference 1.04, 95% CI -0.42 to 2.50), reoperation frequency was similar (22/245 partial vs 28/269 total) and revision rates were 10/245 versus 8/269.

   Beard DJ, Davies LJ, Cook JA, et al. — Total versus partial knee replacement in patients with medial compartment knee osteoarthritis: the TOPKAT RCT.. Health Technology Assessment, 2020. DOI: 10.3310/hta24200.

6. In a structured review of 14 studies covering 6,242 patients with an acutely painful swollen joint (653 with confirmed septic arthritis), no single symptom rules the diagnosis in or out: joint pain was present in 85%, a history of joint swelling in 78%, and fever in only 57%. The most powerful bedside data came from aspirating the joint - the summary likelihood ratio rose with the synovial fluid white cell count, from 0.32 below 25,000/microL to 2.9 at 25,000 or more, 7.7 above 50,000 and 28.0 above 100,000.

   Margaretten ME, Kohlwes J, Moore D, Bent S — Does this adult patient have septic arthritis?. JAMA, 2007. DOI: 10.1001/jama.297.13.1478.