9Selecting those to refer for joint replacement: Who will likely benefit and who will not?
Section snippets
Background
Osteoarthritis (OA) is one of the 10 most disabling diseases in developed countries and worldwide estimates are that 10% of men and 18% of women aged over 60 years have symptomatic OA, including moderate and severe forms [1]. Globally, musculoskeletal (MSK) disorders are the second largest contributor to years lived with disability, with OA of the hips and knees combined being the third most prevalent MSK disorder [2]. Age is the strongest predictor of the development and progression of OA, and
Selecting TJR candidates based on disease severity
It is generally recommended that patients with severe symptomatic OA, who have pain that has failed to respond to conservative treatments and who have progressive limitation in activities of daily living should be referred to an orthopaedic surgeon for evaluation [18]. However, opinions about the indications for TJR based on the severity of joint disease and symptomatology vary greatly between referring physicians and surgeons [19], [20]. While there are no universally accepted criteria to
Modifiable risk factors for poor response to TJR surgery
The decision to refer for surgery based solely on symptoms fails to take into account individual risk factors that can impact on patient outcomes after TJR. A number of associations between individual patient characteristics and response to TJR surgery have been identified including: age [40], gender, body mass index (BMI) *[40], *[41], *[42], *[43], ethnicity [44], psychological distress [45], co-morbidity profile [42] and radiographic OA severity [29], *[46]. The extent to which modifiable
Summary and future directions
The risk factors and predictors of TJR outcome presented in this review by no means form a complete list, but rather highlight those that may be amenable to intervention prior to specialist referral. Addressing modifiable factors such as radiographic OA severity and psychological well-being, for example, prior to referral may improve response rates to TJR surgery. While some algorithms presented in this review are useful in identifying a small subset of patients in whom referral for surgery is
Conflict of interest statement
The authors have no financial and personal relationships with other people or organisations that could inappropriately influence (bias) this work. The authors have no conflicts of interest to declare in relation to this work.
Acknowledgements
Dr. Dowsey holds an NHMRC Early Career Australian Clinical Fellowship (APP1035810).
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