Another reason not to have rigid cutoffs is that third-party payers may use such values in isolation to justify surgical denials, not considering the full clinical picture, Dr. Hannon notes.
“Someone with a BMI of 43 who is otherwise very healthy is very different from the active smoker with type 2 diabetes and a BMI of 45 and an active cardiac history—your willingness to move ahead with surgery is completely different,” says Dr. Hannon.
Emphasis on Shared Decision Making
The importance of shared decision making is a key theme in the guideline, and it was particularly important to the Patient Panel members who contributed their perspectives to the guideline Voting Panel. Members of the Patient Panel stressed the importance of the shared decision-making process in deciding to pursue arthroplasty, considering patients’ unique goals, preferences, risk tolerance, social support, socioeconomic status, medical and psychiatric comorbidities and disease severity.
“The patient and their physician should determine whether and when to proceed with arthroplasty together, after a discussion of the unique risks and benefits of the procedure for the individual patient,” says Dr. Goodman.
Dr. Hannon encourages rheumatologists to reach out early to orthopedic surgeons for their perspective through formal or informal consults, even if it’s not yet clear that a patient is a good candidate for arthroplasty. “I think a lot of us definitely appreciate those collaborations,” he says.
Ruth Jessen Hickman, MD, is a graduate of the Indiana University School of Medicine. She is a freelance medical and science writer living in Bloomington, Ind.
References
- Hannon CP, Goodman SM, Austin MS, et al. 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 sym. Arthritis Rheumatol. 2023 Nov;75(11):1877–1888.
- Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken). 2020 Feb;72(2):149–162.
