This summary was approved by the ACR Board of Directors on February 22. 2023, and the AAHKS Board of Directors on March 8, 2023. These recommendations are included in a full manuscript, which will be submitted for publication in Arthritis & Rheumatology, Arthritis Care and Research, and the Journal of Arthroplasty. *All recommendations are conditional, largely due to the quality of the evidence.
The American College of Rheumatology (ACR) and the American Association of Hip and Knee Surgeons (AAHKS) released a summary of the new guideline for hip and knee replacement timing titled “The Optimal Timing of Elective Hip or Knee Arthroplasty for Patients with Symptomatic Moderate to Severe Osteoarthritis or Osteonecrosis Who Have Failed Nonoperative Therapy.” While previous joint guidelines from the 2 groups focused on the timing of medication use around surgery, this guideline focuses on the timing of hip and knee arthroplasty, and when additional nonoperative treatment or delays for medical optimization are appropriate for patients with advanced osteoarthritis and osteonecrosis who have failed nonoperative therapy.
This guideline follows the ACR guideline development process, which includes the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology, and adheres to the Appraisal of Guidelines for REsearch & Evaluation (AGREE) criteria. A panel of rheumatologists, orthopaedic surgeons, and patients performed a systematic literature review for clinically relevant population, intervention, comparator, and outcomes (PICO) questions, and reached consensus on the following recommendations, taking into consideration available evidence, clinical experience and expertise, and patient values and preferences.
All of the recommendations (see Table) are conditional as the panel graded the available evidence as low or very low quality, primarily due to indirectness. While none are “strong” recommendations, there was high consensus for all of the identified recommendations.
Key among the take-home messages was that the decision of when to proceed with TJA should be made through a shared decision-making process between the physician and patient during which the unique risks and benefits for the individual patient are considered (guiding principle).
Source: ACR/AAHKS. Total Joint Arthroplasty Guideline Summ ry 2023. Available at https://rheumatology.org/indications-for-total-hip-and-knee-arthroplasty-guideline. Accessed May 31, 2023.
