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Joshua Bote USA TODAY
Published 1:47 PM EST Jan 13, 2020
Patients with osteoarthritis in the knee should time the surgery to ensure maximum benefits if they are eligible for knee replacement surgery.
A study by Northwestern University published in the Journal of Bone and Joint Surgery on Monday found that a vast majority of patients who would benefit from knee replacement are taking too long to have surgery, to the detriment of their mobility and overall health.
The researchers followed 8,002 people with or at risk of knee osteoarthritis for up to eight years. Of those, 2,313 people were eligible for and/or received total knee replacement. In total, researchers analyzed 3,417 knees, only 1,114 of which were replaced.
About 90%, or 2,833, of the knees that were “potentially appropriate” for surgery did not have the procedure. Of these, more than 1,200 knees suffered “severe symptoms.”
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Lead investigator Hassan Ghomrawi, an associate professor of surgery at Northwestern University’s Feinberg School of Medicine, said putting off the procedure allows further deterioration of knee function.
“Some of them wouldn’t be able to straighten out their legs, affecting their walking and mobility,” Ghomrawi said in a statement, noting additional cardiovascular health problems could arise because of a lack of exercise.
The study also revealed the lesser-known finding that delayed knee surgery has post-operative recovery ramifications.
“You don’t get as much function back when you wait too long,” Ghomrawi said. “Your mobility is still reduced versus somebody who had it in a timely fashion.”
Why would someone choose to delay knee replacement?
Dr. Mark Pagnano, a professor and chairman of the Department of Orthopedic Surgery at Mayo Clinic, told USA TODAY that despite advancements in the procedure, some people hold on to antiquated notions of its risks and outcomes. He is unaffiliated with the study.
“In the past 10 years, the big story in knee replacement is markedly improved safety of the operation while also decreasing the magnitude of impact on patients, meaning that it’s a much shorter hospital stay or even an outpatient surgery,” said Pagnano, president of The Knee Society.
He also noted patients are now typically allowed to start walking the same day or the day after the procedure.
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Access to care also may play a role. Black people were 2.8 times more likely than their white counterparts to delay knee replacement surgery despite being considered “potentially appropriate,” researchers found.
Pagnano said the finding reflects “greater societal pressures about delivery of medical care in the United States,” including limited access and less familiarity among some groups of patients with the procedure’s benefits.
The new research comes as knee replacements are on the rise, in part because of the aging population and increases in obesity, Pagnano said.
Nearly 1 million knee replacement procedures are performed in the U.S. each year, and a rapid increase is expected by 2030, the paper reports. A 2018 study by the American Academy of Orthopaedic Surgeons found that by 2030, primary knee replacements will increase by a rate of 189%.
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There also may be risks, however, in getting the surgery too early, researchers noted.
About 26% of knee surgeries performed are done prematurely as people who are “likely inappropriate” for the procedure go through with surgery anyway.
Among these patients, the study notes, patients run the risk of complications with less benefit than if the procedure were done later. A second surgery – which may have worse outcomes and is more arduous – may also be necessary.
“There’s a sense among some people that a knee replacement will magically cure any problem that’s related to the knee,” Pagnano said. “And particularly for younger, active patients, they will continue to push and ask for a permanent fix to a problem when perhaps a surgical option is still not in their best interest.”
Follow Joshua Bote on Twitter: @joshua_bote