Total Knee Replacement Delayed With

the leading cause of disability in the United States. The prevalence of OA of the knee in various countries can be estimated as 18% of men and women as inferred by a recent meta-analysis. OA can also result in significant direct and indirect costs, which are higher with greater disability. Current therapeutic options for OA are approved to treat the pain associated with the disorder. The American College of Rheumatology recommends the initial use of nonpharmacologic techniques, such as patient education, weight loss, and physical therapy, followed by pharmacologic therapies such as acetaminophen and cyclooxygenase (COX)-2-specific inhibitors. Intra-articular hyaluronan therapy is recommended for patients who are no longer responsive to nonpharmacologic and pharmacologic treatments or who may be experiencing adverse side effects with nonselective nonsteroidal inflammatory drugs or COX-2-specific inhibitors. Total knee replacement (TKR) is considered a last resort for treatment of OA knee pain in appropriate patients when other therapies fail. According to the National Hospital Discharge Survey published by the U.S. Department of Health & Human Services, approximately 326,000 patients in the United States received a TKR in 2001. In a sample of 6,856 decedents aged ≥65 years, 2.1% were found to have received knee replacements. The cost of knee replacement surgery at patient discharge was reported as $24,045 for 2001. The success of TKR in most patients has been supported by more than 20 years of follow-up data. While TKR is an effective option for OA pain relief for many patients, it is not medically desirable for some patients (age, heart disease, diabetes, pulmonary disease, obesity, or generalized medical debilitation) or is not preferred by others. Additionally, complications of the ABSTRACT