Ask a comedian, tennis player, or chef what’s important in their work. They will tell you it’s timing. Every year 1,200,000 knees are replaced in North America. And just as comedians need good timing, so too this elective surgery. If COVID-19 concerns have you delaying treatment, you may want to think again.
Researchers at the Feinberg School of Medicine of Northwestern University report in the Journal of Bone and Joint Surgery that many people are getting it wrong. Their eight-year study involved 8,002 patients aged 45 to 79 who were at risk of osteoarthritis.
Assessing patients for knee replacement involves consideration of age, severity of symptoms, and what x-rays show of knee damage. Researchers found that 90 percent of people with knee osteoarthritis are delaying too long and missing out on the benefits of replacement.
They also found that 26 percent of patients had surgery too early, adding risk of revision and a second, more difficult surgery later in life.
Black Americans were three times more likely to delay knee surgery than white Americans, even when they met the criteria. Overweight people were also more likely to say no to the procedure. Younger people and those living alone often advanced knee replacement.
So, what is right timing? It depends on several factors and circumstances.
No one likes the prospect of surgery. There’s a basic human desire to put it off. But this decision has consequences. For instance, if a sore knee is keeping you from exercising, walking, or cycling, the cardiovascular system suffers. Delay may set the stage for coronary attack. A more sedentary lifestyle can lead to weight gain and risks for Type 2 diabetes.
Good mobility suggests that strong muscles are supporting the knee. But a lack of exercise causes muscle atrophy, which lengthens recovery time from surgery. Some patients in their desire to postpone surgery elect to have corticosteroid injections. This has been standard treatment to ease pain, but injections come with risks. A study at Boston University showed that frequent injections can increase the risk of cartilage damage, joint and bone destruction, and non-traumatic stress fractures.
If used, they should be limited to two or three injections a year.
But what about rushing into surgery too early? Age is always an important consideration as knee replacements do not last forever. The average artificial joint lasts about 20 years. As the equipment ages, the bond between the implanted joint and the bone may loosen or fail, causing pain, instability, swelling or stiffness.
If discomfort is not significant, it’s prudent to delay surgery. Waiting until you are 65 or older lessens the risk of facing a second operation in the future.
But other less evident factors make the best timing difficult to judge. For example, how significantly is osteoarthritis affecting one’s quality of life? If knee pain is severe and x-rays show extensive damage, it’s time to proceed with surgery.
Before surgery, losing excess weight will decrease the risk of complications. After the operation, walking, golf and cycling are good activities. But sports such as running, tennis and weightlifting cause too much stress on the joint and can weaken it.
For the elderly and others with elevated risk for COVID-19, an important consideration is post-operative recovery in hospital and rehabilitation units. A discussion with your doctor, your family, and a support team should focus on a plan to mitigate risk.