Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021, USA.
Nat Rev Rheumatol. 2013 Jun;9(6):351-7. doi: 10.1038/nrrheum.2013.27. Epub 2013 Mar 12.
Total hip and total knee replacements (THR and TKR respectively), the definitive treatments for end-stage arthritis, are both safe and extremely successful in relieving pain and improving function. However, physicians who care for patients with chronic hip and knee arthritis are often the 'gatekeepers' to total joint replacement (TJR) procedures as they select patients for referral to an orthopaedic surgeon to be considered for arthroplasty. Currently, no evidence-based criteria exist to guide physicians in this decision-making process, and this situation raises the possibility that conscious or unconscious biases may influence referral patterns, potentially leading to systematic inequities regarding which patients are eventually offered TJR. This article reviews why TJRs are particularly important procedures, and highlights common misperceptions among physicians regarding TJR risk assessment. This article also underscores the benefits of ongoing discussion regarding TJR with all patients with moderate-to-severe chronic hip or knee pain and disability.
全髋关节和全膝关节置换术（分别为 THR 和 TKR）是治疗终末期关节炎的确定性疗法，在缓解疼痛和改善功能方面均安全且非常成功。然而，治疗慢性髋膝关节关节炎的医生通常是全关节置换术（TJR）程序的“把关人”，因为他们选择将患者转诊给骨科医生进行关节成形术评估。目前，尚无循证标准来指导医生做出这一决策过程，这种情况增加了有意识或无意识的偏见可能会影响转诊模式的可能性，从而导致最终接受 TJR 的患者存在系统性的不公平。本文回顾了为什么 TJR 是特别重要的程序，并强调了医生在 TJR 风险评估方面的常见误解。本文还强调了与所有中重度慢性髋或膝关节疼痛和残疾患者持续讨论 TJR 的益处。
