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URMC / Research / Research@URMC / June 2014 / Best Time for Joint Replacement? Don’t Wait Too Long

Best Time for Joint Replacement? Don’t Wait Too Long

An analysis of national patient data shows there’s an ideal time for having hip or knee replacement surgery – and it occurs before you can’t walk or take the pain anymore.knee pain skeleton

Regis O’Keefe, M.D., Ph.D., the Marjorie Strong Wehle Professor and chair of the UR Department of Orthopaedics and Rehabilitation, is a member of a national consortium called FORCE-TJR that tracks and reports data on a wide range of quality measures. FORCE-TJR also produces evidence-based benchmarks for orthopaedic surgeons across the United States.

The task force studied data from 17,000 patients and discovered that by establishing uniform composite scores for pain and functional levels, they could help patients and physicians make better decisions about when to have surgery. By looking at where a patient falls on the pain/functionality spectrum and comparing that assessment to others, doctors can time surgery to achieve the best outcome.

For example, the nationally recognized composite score for someone with no pain or joint difficulty is 50.  The level of pain associated with arthritis is thought to be around 32.  And the new data shows that surgery improves a person’s score by an average of 12 points. So, if a patient waits until his or her joint pain/function score is 25 or lower, the improvement in pain and function after surgery will most likely fall short of 50 as the goal.

Uniformity in scores across a wide population provides statistically-relevant data to guide decision-making, O’Keefe said. Exceptions always exist, but patients who wait until the function of their knees and hips are extremely impaired won’t achieve the same benefits from surgery as someone who chooses surgery at the ideal time, the data showed.

David Ayers, M.D., and Patricia Franklin, M.D., M.B.A., M.P.H., of the University of Massachusetts Medical School, lead the FORCE-TJR monitoring program.

Leslie Orr | 6/18/2014

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