ACR and AAHKS to Release Guidelines for Optimal Timing of Total Joint Arthroplasty in OA

The American College of Rheumatology (ACR) and the American Association of Hip and Knee Surgeons (AAHKS) will release guidelines for the optimal timing of hip and knee arthroplasty for patients with symptomatic moderate to severe osteoarthritis (OA) or osteonecrosis with an inadequate response to nonoperative therapy. The guideline summary is available on the ACR website.

A panel of rheumatologists, orthopedic surgeons, and patients developed recommendations using available evidence, clinical experience, and patient values and preferences. All recommendations were conditional, largely due to the low evidence quality; however, the consensus for each was strong.

1. The panel conditionally recommended against delaying total joint arthroplasty (TJA) to pursue further nonoperative treatments, including physical therapy; nonsteroidal anti-inflammatory agents; braces ambulatory aids; intra-articular glucocorticoid injections; and viscosupplementation injections.
2. The panel recommended against delaying TJA to achieve weight reduction among patients with a body mass index (BMI) of greater than 35. They added that a required weight or BMI should not be set for surgery.
3. The panel recommended that TJA should not be delayed in patients with bone loss, severe deformity, or ligamentous instability.
4. The panel also recommended against delaying TJA in patients with a neuropathic joint.
5. The panel recommended that TJA be delayed to improve glycemic control in patients with diabetes mellitus; however, a specific measure or threshold of glycemic control was recommended against.
6. The panel also recommended that TJA be delayed to achieve nicotine cessation or reduction in patients with nicotine dependence.

The authors of the guidelines noted, “The…decision of when to proceed with TJA should be made through a shared decision-making process between the physician and patient during which the unique risks and benefits for the individual patient are considered.”