Hassan M.K. Ghomrawi
Results published in the Journal of Bone and Joint Surgery showed a substantial number of patients with knee osteoarthritis underwent either premature or delayed total knee replacement more than 2 years after it had become potentially appropriate.
Hassan M.K. Ghomrawi, PhD, MPH, and colleagues pooled demographic, patient-reported, radiographic, clinical examination and TKA utilization information longitudinally for 8,002 patients across two multicenter cohort studies who had or were at risk for knee OA. Researchers classified patients as either potentially appropriate or likely inappropriate for TKA using validated TKA appropriateness criteria. Researchers also classified patients based on whether they underwent TKA within 2 years after the procedure had become potentially appropriate (timely group), did not undergo TKA for more than 2 years after the procedure had become potentially appropriate (potentially appropriate but not replaced group) or underwent TKA even though the procedure was likely inappropriate (premature group).
Of the 3,417 patients included in the study, results showed 290 knees were classified in the timely group, 2,833 knees in the potentially appropriate but not replaced group and 294 knees in the premature group. Researchers noted 42.5% of patients in the potentially appropriate but not replaced group had severe symptoms. Participants who were black had a greater likelihood of being classified in the potentially appropriate but not undergoing TKA group compared with patients who underwent timely total knee replacement, according to results. Researchers also found patients with a BMI greater than 25kg/m2 and patients with depression had a lower likelihood of undergoing TKA prematurely.
“Patients with knee OA are not undergoing the surgery at optimal timing. Because total knee replacement is an elective procedure, our findings call for a deeper understanding of why people go early or delay. Some of these timings are justified and sometimes necessary, but people and health systems and [account care organizations] ACOs need to know the consequences of their decisions,” Ghomrawi told Healio Orthopedics. “The algorithms we used in our study have clinical utility that would help physicians and their patients to hopefully make some more informed decisions ,and I encourage them to start using them in the practices while counseling patients. Patients with knee pain also need to regularly follow up on their knee pain with their doctors. The algorithms will not help if patients manage on their own.” – by Casey Tingle
Disclosures: Ghomrawi reports he received a grant and a P-30 grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Please see the study for all other authors’ relevant financial disclosures.