Clinical Paper Review: Patient factors in the decision to delay Total Knee Arthroplasty


A recent study by Zhao, R. et al1, analysed U.S. patients' perspectives and the factors in choosing to delay TKA (Total Knee Arthroplasty).

"Delaying total knee arthroplasty (TKA) carries an increased likelihood of poor rehabilitation outcomes. TKA candidates may choose to delay surgery for a variety of reasons including perceptions of pain and interference with activities due to pain."1

Summary of Study:

An online survey was conducted of 654 U.S. patients who suffered from arthritis and were candidates for TKA. Questions were related to:

  • Pain severity
  • Activity interference due to pain
  • Pain management
  • The decision to delay TKA surgery
  • Demographic information


Patients concerned about experiencing pain (first several weeks following surgery) had significantly higher odds of delaying surgery. Patients concerned about the interference of surgery with work were also more likely to decide to delay knee replacement surgery. Additionally, 92% of patients indicated they would seek surgeons who offered an effective non-opiate pain management option during the rehabilitation period.1

The Oxford® Partial Knee

Today, PKA is only used for approximately 8% of all knee replacements worldwide2,3, however one study showed that 47.6% of all knee replacement patients were candidates for PKA4.

Benefits of PKA may include:

  • A shorter hospital stay5 with less early complications compared to total knee replacement5,6*.
  • A more rapid recovery has been reported with a minimally invasive technique used in Oxford Partial Knee replacement compared to total knee replacement5,7.
  • One study found that Oxford PKR patients experienced less pain in low-impact sports (swimming, cycling, hiking and golf) compared to TKA patients8.
* Study included Oxford Partial Knees as well as other partial knee replacements
  1. Zhao R, et al. Patient factors in the decision to delay total knee arthroplasty. Presented at the International Society for Pharmacoeconomics and Outcomes Research 20th Annual International Meeting, May 16-20, 2015, in Philadelphia, Pennsylvania.
  2. European Millennium Report Study 2013.
  3. US Millennium Study 2013.
  4. Willis-Owen, et al. Unicondylar knee arthroplasty in the UK National Health Service: An analysis of candidacy, outcome and cost efficacy. ScienceDirect. The Knee 16. 473-478. 2009
  5. Lombardi, A. et al. Is Recovery Faster for Mobile-bearing Unicompartmental than Total Knee Arthroplasty? Clinical Orthopedics and Related Research. 467:1450-57. 2009.
  6. Brown, NM, et al. Total Knee Arthroplasty Has Higher Postoperative Morbidity Than Unicompartmental Knee Arthroplasty: A Multicenter Analysis. The Journal of Arthroplasty. Vol. 27 No. 8 Suppl. 1 2012
  7. Price AJ et al. Rapid Recovery After Oxford Unicompartmental Arthroplasty through a short incision. The Journal of Arthroplasty Vol 16 No. 8. 2001
  8. Walton, NP. et al. Patient-Perceived Outcomes and Return to Sport and Work: TKA Versus Mini-Incision Unicompartmental. Knee Arthroplasty. The Journal of Knee Surgery. 2006;19:112-116.