Posted on 04/09/2023 3:39:32 PM PDT by ConservativeMind
For patients with symptomatic, radiographic, moderate-to-severe osteoarthritis or osteonecrosis of the hip or knee, total joint arthroplasty (TJA) should not be delayed in order to pursue additional nonoperative treatments, according to a clinical practice guideline issued by the American College of Rheumatology and the American Association of Hip and Knee Surgeons.
Susan M. Goodman, M.D. and colleagues conducted a review of the literature to develop recommendations for the optimal timing of hip and knee arthroplasty on patient outcomes, including pain, function, infection, hospitalization, and death at one year among people with symptomatic, radiographic, moderate-to-severe osteoarthritis or osteonecrosis of the hip or knee who have decided to undergo elective hip or knee arthroplasty after previously attempting nonoperative treatment.
The authors recommend a shared decision-making process between the physician and patient, considering the unique risks and benefits, in order to decide when to proceed with TJA. Conditional recommendations include not delaying TJA to pursue additional nonoperative treatments; delaying TJA to achieve nicotine cessation or reduction; delaying TJA to improve glycemic control among patients with diabetes mellitus; and not delaying surgery due to obesity but encouraging weight loss.
"There is no evidence that delaying surgery for any of the additional nonoperative treatments studied, including physical therapy, gait aids, oral anti-inflammatories, or injections, leads to improved outcomes, and may burden patients without clear benefit," Goodman said in a statement.
(Excerpt) Read more at medicalxpress.com ...
Both knees I had to go thru a routine of PT, then cortisone shots, then syn-visc injections, finally the approval for replacement.
1st knee took 10 months for approval then second knee 8 months.
In the UK, they found it politically more popular to give 100 young women pre-natal care than to give one old woman a knee.
So pretty obvious who wins...
In essence, it seems if you already have a bad situation, there are just a few reasons to not immediately go forward with this surgery, if you were already wanting to go forward and timing was an issue.
My wife was in pain 24/7 in need of a hip replacment. Her operation was delayed for close to a year due to Covid impact on our ppo.
Nothing worked and she will not take narcotics more than a couple of doses. She was in pain for months as nothing worked.
A year ago on 1 March, she had her replacement. She took drugs for about 2-3 days and went to ice and heat prn.
A year later, she is better with basically zero pain and gains more mobility each day.
That is exactly what I think they are saying. Don’t delay and get on recovering from the operation.
She might be one of those people that have problems with P450 enzyme .
Painkillers can be problematic. I don’t process Oxy, Vicodin, etc the way “normal” people do. Not sure I even process ibuprofen correctly because it does nothing for me.
Those with progressively increasing pain and stiffness and decreasing daily function despite attempting all the general non-surgical options should consider total joint replacement.
Any major joint work should be done ASAP.
I had my left foot rebuilt last August 8th. Prior to that I woke up in pain and each thing I did throughout the day made the pain worse. My doctor prescribed exercise and would not refer me to a specialist. I switched doctors and had the operation right away, within a few weeks (which was on Aug 8).
Now with no pain my energy levels are about the same as when I was 60 (I’m 73 now). I put in 8 - 10 hours daily working on equipment or in the forest. Prior to that I could not do 2 or three hours per day.
Now my new doctor wants to have my left knee rebuilt. No shots, no PT - no prerequisites at all. The new doc referred me to a specialist with a surgery date of July 31st.
My advice to anyone with joint issues is DO IT NOW!. Save your self pain and agony!. There’s no reason to ever be in a walker or wheel chair because of joint issues if you take care of it early.
60-90 days post op and with her new hip, most of the hip pain my wife had just faded away.
She was an RN for most of her adult life and has seen too many adults get addicted to the opiates.
We both have high pain levels and avoid any narcotics unless our Doctors, say, “Take the damn pills!”.
‘That is exactly what I think they are saying.!’
“Don’t delay and get on recovering from the operation.”
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