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

Publication Date: September 25, 2023
Last Updated: October 3, 2023

Summary of Recommendations

Target group

For patients with radiographically moderate to severe OA or ON of the hip or knee using standard radiographic grading such as Kellgren-Lawrence or Tonnis, and moderate to severe pain or loss of function who have been indicated for elective total joint arthroplasty (TJA) through a shared decision-making process with their physician and have completed one or more trials of appropriate nonoperative therapy.
In our defined population, we conditionally recommend proceeding to TJA without delay over delaying arthroplasty three months. (Very low-quality evidence, Conditional recommendation)
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In our defined population, we conditionally recommend proceeding to TJA without delay over delaying arthroplasty for a trial of physical therapy. (Low-quality evidence, Conditional recommendation)
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In our defined population, we conditionally recommend proceeding to TJA without delay over delaying surgical treatment for a trial of NSAIDs. (Very low-quality evidence, Conditional recommendation)
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In our defined population, we conditionally recommend proceeding to TJA without delay over delaying surgical treatment for a trial of braces and/or ambulatory aids. (Very low-quality evidence, Conditional recommendation)
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In our defined population, we conditionally recommend proceeding to TJA without delay over delaying surgical treatment for a trial of intra-articular glucocorticoid injections. (Very low-quality evidence, Conditional recommendation)
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In our defined population, we conditionally recommend proceeding to TJA without delay over delaying surgical treatment for a trial of viscosupplementation injections. (Very low-quality evidence, Conditional recommendation)
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In our defined population with body mass index (BMI) >50, we conditionally recommend proceeding to TJA without delaying to achieve weight reduction to BMI <50. (Very low-quality evidence, Conditional recommendation)
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In our defined population with BMI 40–49, we conditionally recommend proceeding to TJA without delaying to achieve weight reduction to BMI <40. (Very low-quality evidence, Conditional recommendation)
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In our defined population with BMI 35–39, we conditionally recommend proceeding to TJA without delaying to achieve weight reduction to BMI <35. (Very low-quality evidence, Conditional recommendation)
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In our defined population with poorly controlled diabetes mellitus, we conditionally recommend delaying TJA to improve glycemic control. (Very low-quality evidence, Conditional recommendation)
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In our defined population with nicotine dependence, we conditionally recommend delaying TJA for nicotine use reduction/cessation. (Low-quality evidence, Conditional recommendation)
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In our defined population with bone loss with deformity or severe ligamentous instability, we conditionally recommend proceeding to TJA without delay over delaying arthroplasty for optimization of non-life-threatening conditions (Level of Evidence: N/A) (, Conditional recommendation)
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In our defined population with a neuropathic joint, we conditionally recommend proceeding to TJA without delay over delaying for optimization of non-life-threatening conditions. (Level of Evidence: N/A) (, Conditional recommendation)
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Video

Recommendation Grading

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.

Overview

Title

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

Authoring Organizations

Publication Month/Year

September 25, 2023

Last Updated Month/Year

February 7, 2024

Supplemental Implementation Tools

Document Type

Guideline

Country of Publication

US

Document Objectives

To develop evidence-based consensus recommendations for the optimal timing of hip and knee arthroplasty to improve patient-important outcomes including, but not limited to, pain, function, infection, hospitalization, and death at 1 year for patients with symptomatic and radiographic moderate-to-severe osteoarthritis or advanced symptomatic osteonecrosis with secondary arthritis of the hip or knee who have previously attempted nonoperative therapy, and for whom nonoperative therapy was ineffective, and who have chosen to undergo elective hip or knee arthroplasty (collectively referred to as TJA).

Inclusion Criteria

Male, Female, Adult, Older adult

Health Care Settings

Ambulatory, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Counseling, Treatment, Management

Diseases/Conditions (MeSH)

D019645 - Arthroplasty, Replacement, Knee, D019643 - Arthroplasty, Replacement, D001178 - Arthroplasty, D019644 - Arthroplasty, Replacement, Hip

Keywords

osteoarthritis, arthroplasty, Osteonecrosis, hip osteoarthritis, knee osteoarthritis, total joint arthroplasty (TJA), total joint arthroplasty, TJA, total hip replacement, total knee replacement

Source Citation

Hannon, C.P., Goodman, S.M., Austin, M.S., Yates, A., Jr., Guyatt, G., Aggarwal, V.K., Baker, J.F., Bass, P., Bekele, D.I., Dass, D., Ghomrawi, H.M.K., Jevsevar, D.S., Kwoh, C.K., Lajam, C.M., Meng, C.F., Moreland, L.W., Suleiman, L.I., Wolfstadt, J., Bartosiak, K., Bedard, N.A., Blevins, J.L., Cohen-Rosenblum, A., Courtney, P.M., Fernandez-Ruiz, R., Gausden, E.B., Ghosh, N., King, L.K., Meara, A.S., Mehta, B., Mirza, R., Rana, A.J., Sullivan, N., Turgunbaev, M., Wysham, K.D., Yip, K., Yue, L., Zywiel, M.G., Russell, L., Turner, A.S. and Singh, J.A. (2023), 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 Rheumatol. https://doi.org/10.1002/art.42630

Methodology

Number of Source Documents
58
Literature Search Start Date
September 27, 2021
Literature Search End Date
June 19, 2022