In order to investigate this observation, data were pooled from two multicenter cohort studies. These studies collected demographic, patient-reported, radiographic, clinical examination and total knee replacement utilization information. Validated total knee replacement appropriateness criteria were longitudinally applied to classify participants as being either potentially appropriate or likely inappropriate for the operation.
Patients were further classified on the basis of knee replacement utilization rates into three categories: timely, potentially appropriate, and premature. Utilization rates were calculated and factors associated with each category were identified.
The results showed that 290 knees (8%) classified as “timely”, 2833 (83%) were classified as “potentially appropriate but not replaced”, and 294 knees (9%) were considered to be “likely inappropriate”. Of the knees that were potentially appropriate but not replaced 1204 (42.5%) had severe symptoms.
The investigators concluded that substantial numbers of patients have premature total knee replacement and there are also many patients for whom total knee replacement is potentially appropriate but it’s not being performed. Undergoing total knee replacement too early may result in little or no benefit whereas waiting too long result in limitations in physical activity. The investigators calculated the extent of premature, timely and delayed use and found a high prevalence of both premature and delayed use patients.
Ghomrawi, HMK et al.: J. Bone Joint Surg.102:468-476, 2020.