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Patients with severe knee pain from degenerative arthritis should have a TKR when it doesn't respond to pain relievers.
Patients with dementia or other psychiatric disorders should not have a TKR.
The authors of this study reviewed 611 other articles written about this operation. They reported other findings on TKR from nine of those articles. They found that TKR is effective in reducing pain and improving quality of life for patients with destructive knee arthritis.
Before having a TKR most patients went through a long period of conservative care. Treatment included drugs, injections, and exercise. Some even had other kinds of surgery first trying to save the joint.
There was very little agreement among surgeons, rheumatologists, and primary care physicians on when TKR should be done. There were dozens of other patient factors used by doctors when considering a TKA. There was consensus only on the two factors listed above. When medical management is unsuccessful, then most doctors agree that surgery is the next step.
The authors conclude there simply isn't enough evidence one way or the other to decide which patient factors clearly point to the need for TKR. There aren't really even any studies to support or reject the use of TKRs in patients with dementia. More research is needed before standards can be set for patient selection.
When Should You Have a Total Knee Replacement?
When it comes to deciding who should or shouldn't have a total knee replacement (TKR), surgeons agree on two things:
The authors of this study reviewed 611 other articles written about this operation. They reported other findings on TKR from nine of those articles. They found that TKR is effective in reducing pain and improving quality of life for patients with destructive knee arthritis.
Before having a TKR most patients went through a long period of conservative care. Treatment included drugs, injections, and exercise. Some even had other kinds of surgery first trying to save the joint.
There was very little agreement among surgeons, rheumatologists, and primary care physicians on when TKR should be done. There were dozens of other patient factors used by doctors when considering a TKA. There was consensus only on the two factors listed above. When medical management is unsuccessful, then most doctors agree that surgery is the next step.
The authors conclude there simply isn't enough evidence one way or the other to decide which patient factors clearly point to the need for TKR. There aren't really even any studies to support or reject the use of TKRs in patients with dementia. More research is needed before standards can be set for patient selection.
References: William W. Cross, III, MD, et al. Agreement About Indications for Total Knee Arthroplasty. In Clinical Orthopaedics and Related Research. May 2006. No. 446. Pp. 34-39.
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