Priority 2 from the Hip and Knee Replacement for Osteoarthritis PSP

UNCERTAINTY: What is the optimal timing for hip and knee replacement surgery, in people with OA, for best post operative outcomes? (JLA PSP Priority 2)
Overall ranking	2
JLA question ID	0020/2
Explanatory note	Not available for this PSP
Evidence	None available
Health Research Classification System category	Musculoskeletal

Extra information provided by this PSP
Original uncertainty examples	What is the optimal waiting time between deciding to replace joints and undergoing surgery to improve post-operative outcomes in patients undergoing hip and knee joint replacement? ~ Do longer waiting times for knee/hip joint replacement surgery increase the incidence of post-operative complications (eg: DVT, pain) in patients undergoing these operations? ~ What is the optimal waiting time for TKR after decision to operate ~ My mum had hip OA and went through best practice pathways with my support (I'm a pain consultant) & had huge problems with pain relief. She was very ready for a joint replacement but the wait was unacceptable, she had a DVT, PE and MI due to her immobility. We must surely be wasting scarce resources by denying effective treatment to patients when they are ready. ~ How aware are GPs of the progression pathway to be able to make more timely referrals? ~ Is it better to go for surgery earlier? Does this make the success rate better? ~ How do I decide when to have a TKR when my GP just says 'you decide, you will know when!'?
Submitted by	Uncertainty identified by 26 patient/carers, 2 clinicians, and from 1 patient/ carer discussion group
Outcomes to be measured	Post-operative outcomes

PSP information
PSP unique ID	0020
PSP name	Hip and Knee Replacement for Osteoarthritis
Total number of uncertainties identified by this PSP.	123 (To see more about the Top 10, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop	27 March 2014