A Third of Total Knee Arthroplasty in the U.S. Deemed Inappropriate

by | Last updated Jun 29, 2023 | Published on Aug 13, 2014 | Healthcare News

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Knee replacement is an effective orthopedic operative procedure for people with severe knee damage from arthritis or injury. This procedure is proven to relieve pain, correct leg deformity, and helps people quickly resume normal activities. According to the Agency for Healthcare Research and Quality, more than 600,000 knee replacements are performed each year in the United States.

The study, published in the June issue of Journal of Bone and Joint Surgery, found that total knee replacements more than tripled between 1993 and 2009. An increase in the prevalence of overweight and obesity in the U.S. accounted for 95 percent of the higher demand for knee replacements, with younger patients affected to a greater degree. This study also noted that hospital reimbursement, length of hospital stay and in-hospital mortality for this procedure also comparably declined between 1995 and 2009.

An article published online in Arthritis & Rheumatism, a journal of the American College of Rheumatology finds that approximately a third of total knee arthroplasty (TKA) surgeries were judged to be inappropriate. This is the first US study to compare validated appropriateness criteria with actual cases of knee replacement surgery.

The study was led by researchers from the Department of Physical Therapy, Department of Orthopedic Surgery, and Department of Radiology, Virginia Commonwealth University, Richmond. Data from 205 knee replacement patients was examined, and was classified as appropriate, inconclusive, or inappropriate.

A modified version of the appropriateness classification system developed by Escobar et al., and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) Pain and Physical Function scales were used to assess participants enrolled in the Osteoarthritis Initiative – a prospective 5-year study funded in part by the National Institutes of Health (NIH).

The mean age for the surgery was 67 years and 60% of the group was female. Analyses showed that:

  • 44% of surgeries was appropriate
  • 21.7% was inconclusive
  • 34.3% deemed inappropriate

The study highlights the need for consensus on patient selection criteria among U.S. medical professionals treating those with the potential need of knee replacement surgery.

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