Edito of 02/27/2014
The implanting of a prosthetic device (knee or hip) is considered when the disability caused by the pain and functional impairment can no longer be controlled by a correctly monitored medical treatment.
As far as the progression of arthritis is concerned, there is a moment when the patient's level of motor activity starts to decline unavoidably. This happens when their medical treatment is no longer able to keep the pain down to a tolerable level or to enable a sufficient level of mobility in the joints.
With arthritis in the knee or hip, when the idea of a prosthetic device has to be discussed with the patient, the Lequesne Algofunctional Index (which is calculated on the basis of pain levels, walking distance and the level of difficulty involved in performing certain everyday acts) is more relevant than the intensity of radiological destruction in the joints.
It is not rare for there to be a mismatch between the level of perceived disability and the Algofunctional Index, with the “perceived” disability being too high for an index that is relatively weak. This is why patients' needs and expectations should be taken into consideration, and why it may in some cases be appropriate to use self-assessment scales.
It is not the disability that indicates when preventive surgery should be carried out: instead, it's the coexistence of a number of early signs of arthritis and anatomical anomalies (hip dysplasia) or disorders when not moving, such as genu varum (bowleg) or genu valgum (knock-knee). Its distinctive feature is that it should be recommended sufficiently early (before it's too late), because the results can be effective for many years.
Arthrolink Editorial Committee