Osteoarthritis is the most common joint disease there is. It is characterized by a destruction of the cartilage which extends to all the structures of the joint. One of its most common forms is at the knee. In France, osteoarthritis of the knee thus affects 30% of people aged 65 to 75 and is very debilitating because it affects large joints that carry the weight of the body. In the case of diffuse and advanced involvement, many people are offered a arthroplasty, an operation to replace all or part of the knee joint with a prosthesis. Unfortunately, most people tend to wait too long before having the operation and get less benefit from it, while having it too early is not good either. These are the main conclusions of a study published on Monday, January 13 in the Journal of Bone and Joint Surgery.
In the United States, nearly one million knee replacement procedures are performed each year, and these increases are expected to increase rapidly by 2030, say the authors of the article. “As the number of operations increases, we need to ensure that there is an optimal time for patients to benefit most and that healthcare costs remain low,” notes Hassan Ghomrawi, associate professor of surgery at Northwestern University Feinberg School of Medicine and principal investigator of the study.
“As knee replacement surgery is a non-emergency procedure, the timing of the operation depends not only on clinical factors, but also on demographic, socio-economic and socio-cultural factors. We need to develop a better understanding of these factors to improve the timing of the operation, ”he continues.
“The overall impact can be huge”
He and his colleagues therefore followed 8,002 participants who suffered or were at risk of osteoarthritis of the knee for up to eight years. They found that 90% of patients with osteoarthritis of the knee wait too long before undergoing the operation and get less benefit from it. In detail, African-Americans tended to delay intervention more than Caucasians.
“When people wait too long, two things happen: osteoarthritis causes their function to deteriorate. Some of them could not straighten their legs, which affects their walking and mobility. When you can’t exercise, you can start developing other health problems like cardiovascular problems. You may also become depressed. The overall impact can be huge, ”says Ghomrawi.
What is more, delaying surgery limits the benefits that the patient can later gain. “You don’t get as many functions when you wait too long; your mobility is always reduced compared to someone who had it in good time ”, develops the researcher.
25% of patients undergo the operation too early
On the contrary, around 25% of patients undergo the operation prematurely. This leads to risks of complications and limits the benefits. For example, patients may need a second surgery later in their lives. The latter will then be much more complicated to perform and the results even worse.
This is the first study to prospectively examine the advisability of a knee replacement in such a large number of patients.
If this research focuses on osteoarthritis of the knee, this disease can unfortunately affect all joints. Its symptoms depend on the level of activity of the person and sometimes appear following a trivial accident, the lesions having remained painless until then.
For mild osteoarthritis, doctors suggest a adapted physiotherapy, temporary rest and painkillers. If the osteoarthritis progresses but remains limited to one of the parts of the joints, the patient is often suggested an osteotomy to correct the axis of the lower limb and to discharge the portion of the joint where the osteoarthritis is located. Finally, in case of advanced disease and failure of conventional treatment, the operation will be considered.
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