Waiting Too Long for TJR is a Bad Idea

Is there an optimum time—a window of opportunity—for a patient to get a hip or knee joint replaced? Data from a joint replacement monitoring program and database at UMass Medical School says “yes” and that waiting too long will reduce the benefits of surgery.

“Don’t wait until you can’t walk or take the pain any longer, ” said David Ayers, M.D., the Arthur M. Pappas Chair in Orthopedics, professor of orthopedics and physical rehabilitation and director of the Musculoskeletal Center of Excellence. “That’s what we hear a lot from patients and doctors—to wait until you can’t take it anymore. But the data is telling us that for typical patients, there’s only a fixed amount of improvement you can get from surgery. So if you wait too long, you don’t get the full value.”

Ayers said that this is not about having surgery too early, either. Instead he says that doctors now have objective, data-driven tools that can help patients decide, together with their surgeons, where they are with pain and function and when to have surgery.

The nationally-recognized physical composite score for an individual with no joint pain or functional difficulty is 50. The new data, based on a study of 17, 000 patients, reveals that typical patient scores improve an average of 12 points after total joint replacement (TJR) surgery. Because patients on average experience the same change in functional improvement after surgery, a typical patient who waits until his function is extremely impaired will not achieve the same degree of post-operative function as will a typical patient who chooses surgery at the ideal time.

“What we’re seeing is that the average person who chooses total joint replacement has an average pre-total joint replacement function score of 32, ” said Patricia Franklin, M.D., professor of orthopedics and physical rehabilitations. “On average, TJR patients can achieve scores of 44 or greater and approach the function of non-arthritic patients after surgery. But, 20% of patients who wait until their score is 25 or lower generally don’t get the full 12 points of improvement. In fact, 40% of those who wait this long only achieve post-surgery function at the arthritis level of 32. If 50 is the goal, these are important measures for patients and surgeons to monitor when deciding on joint replacement surgery timing, ” said Franklin.