Prolonged Conservative Management in Total Joint Arthroplasty: Harming the Patient?

It is important to understand the long-term consequences of postponing total joint arthroplasty until the onset of severe functional impairment. Therefore, the purpose of this investigation was to determine and compare the midterm to long-term postoperative outcomes of patients who underwent total joint arthroplasty with severe vs less severe preoperative functional impairment.

A total of 105 primary unilateral total hip/knee arthroplasty patients were studied. Patients were divided into 2 groups-severely functionally impaired (preoperative Western Ontario and McMaster Osteoarthritis Index function ≥51 points) and functionally impaired (preoperative Western Ontario and McMaster Osteoarthritis Index function <51 points).

At an average of 11.2 years postoperatively, the patients who were severely functionally impaired preoperatively had worse outcomes than did the patients with less severe preoperative functional impairment.

Our data suggest that, after surgery, it is unlikely that patients who are severely functionally impaired preoperatively will ever catch up to patients who have the surgery with less severe functional impairment.