New recommendations for optimal timing of elective hip or knee arthroplasty released

The American College of Rheumatology (ACR) and the American Association of Hip and Knee Surgeons (AAHKS) have released new recommendations on the optimal timing for elective hip or knee replacements. As per the new recommendation, patients with moderate to severe osteoarthritis and osteonecrosis who have not responded to nonsurgical therapies should proceed to surgery without further delay.

The ACR and AAHKS have approved 13 recommendations. The complete manuscript with detailed recommendations is under peer review in ACR and AAHKS journals. The task team responsible for drafting these recommendations consisted of rheumatologists, orthopaedic surgeons, and patient advocates, and each recommendation had a high level of support within the team.

According to Susan M. Goodman, the co-principal investigator of the task team, delaying surgery for any of the additional nonoperative treatments such as physical therapy, gait aids, oral anti-inflammatories, or injections does not improve outcomes and may burden patients without obvious benefit. Another major recommendation is that patients with diabetes or nicotine dependence postpone surgery should quit nicotine use or decrease nicotine products in order to improve glycemic control. Additionally, patients with substantial ligamentous instability or bone loss with deformity are advised to undergo surgery without delay, and individuals with one or more neuropathic joints are recommended to undergo surgery without delay to improve care.

The task team has also emphasized the importance of shared dec ion-making between a patient and their physician to discuss the risks and benefits of a procedure upon scheduling a patient for total joint arthroplasty. The guidelines have also underscored on preoperative attempts to modify the risk factors through efforts such as weight loss, glycemic control, or smoking cessation.


  1. New Guideline Introduces Recommendations for Optimal Timing of Elective Hip or Knee Arthroplasty. American College of Rheumatology.