Too Many People Delay Knee Replacement Surgery

With an aging population, more and more Americans are undergoing knee replacement surgery. More than 600,000 knee replacements are done each year in the United States and that number is expected to rise to 1.28 million by 2030, according to data from the American Academy of Orthopaedic Surgeons. Unfortunately, many people are not having the best outcomes because they have waited too long to have the surgery. This issue is the basis of a report recently published in the Journal of Bone and Joint Surgery.

Hassan Ghomrawi, PhD, MPH, associate professor of surgery at Northwestern University Feinberg School of Medicine, and his team devised a new algorithm to help physicians and patients figure out the right time to have surgery. It was based on information from 8,002 people who had or were at risk for osteoarthritis and incorporates joint function, pain, radiographic assessment, and age. Based on the algorithm and the researchers follow-up data, 90 percent of patients with osteoarthritis in their knees wait too long to get a replacement and about 25 percent of people who don’t yet need it are having the procedure done too soon.

Patients who wait too long don’t get as many benefits from the surgery as they could. They don’t get as much function back. Patients who have surgery too soon may wind up having a revision surgery later in life. Revisions can be more difficult and result in poorer outcomes. The researchers found that blacks are more likely than whites to delay knee replacement surgery.

The new algorithm could be helpful when doctors and patients are determining the right time for the patient to undergo knee replacement surgery. Ghomrawi said, “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.”