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Orthop Nurs. 2013 Jan-Feb;32(1):6-13; quiz 14-5. doi: 10.1097/NOR.0b013e31827d96be.

The cycle of comorbidities: potential risks with delayed joint replacement.

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  • 1Stanford University Medical Center, Boswell Joint Replacement Clinic, Palo Alto, CA, USA.


Joint replacement is an option that has demonstrated significant improvement in the quality of life for individuals with severe arthritis. However, it is often delayed either in an attempt to avoid future revision surgeries or for other personal reasons. Increasing disability leads to inactivity, chronic pain, and sleep disruption, each of which cycles into significant comorbid risks, many of which are life-threatening. A beginning conceptual framework identified as the cycle of comorbidities is presented to identify these risks and help guide both the patient and the provider in the decision-making process associated with joint replacement surgery.

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