When Should Elective Total Hip or Knee Arthroplasty Be Delayed to Optimize Outcomes?

Background

At some point in the progression of knee or hip osteoarthritis (OA), patients and their physicians might turn to total joint arthroplasty (TJA) as the preferred next step. However, patients sometimes encounter obstacles to proceeding with TJA. Two common ones are third-party mandates (e.g., insurance company requirements for patients to undergo additional nonoperative interventions, such as physical therapy, before approving TJA) and institutional or surgeon-specific clinical mandates (e.g., requiring body-mass index [BMI] or glycosylated hemoglobin [HbA_1c] level to be below a certain threshold). This new guideline — produced…