2023 American College of Rheumatology and American Association of Hip and Knee Surgeons Clinical Practice Guideline for the Optimal Timing of Elective Hip or Knee Arthroplasty for Patients With Symptomatic Moderate‐to‐Severe Osteoarthritis or Advanced Symptomatic Osteonecrosis With Secondary Arthritis for Whom Nonoperative Therapy Is Ineffective
Methodological detailssystematic literature review, GRADE, Voting Panel consensus, 13 PICO questions; Voting Panel of 13 physicians and patients
- Systematic literature review
- GRADE
- Voting Panel consensus
- 13 PICO questions; Voting Panel of 13 physicians and patients
Recommendations
As issued by the authors
- conditional
Against delaying TJA to pursue additional nonoperative treatment (physical therapy, NSAIDs, ambulatory aids, intraarticular injections)
- conditional
Delay TJA for nicotine reduction or cessation
- conditional
Delay for better glycemic control in patients with diabetes mellitus; no specific measure or level identified
- consensus
Obesity by itself is not a reason for delay; weight loss should be strongly encouraged and the increase in operative risk discussed
- conditional
Against delay in patients with severe deformity or bone loss, or a neuropathic joint
- low or very low quality evidence
Evidence for all recommendations graded low or very low quality
Original publication
2023 American College of Rheumatology and American Association of Hip and Knee Surgeons Clinical Practice Guideline for the Optimal Timing of Elective Hip or Knee Arthroplasty for Patients With Symptomatic Moderate‐to‐Severe Osteoarthritis or Advanced Symptomatic Osteonecrosis With Secondary Arthritis for Whom Nonoperative Therapy Is Ineffective. Arthritis Rheumatol. Published 25 September 2023. doi:10.
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