Author Interviews, BMJ, Cost of Health Care, Orthopedics / 29.03.2017
Knee Replacement Would Be More Cost Effective If Limited To Those With Severe Symptoms
MedicalResearch.com Interview with:
Bart S Ferket, MD, PhD
Assistant Professor, Population Health Science and Policy
Icahn School of Medicine at Mount Sinai
MedicalResearch.com: What is the background for this study?
Response: The annual rate of total knee replacement in the US has doubled since 2000, and especially in those aged 45-65 utilization of this procedure has increased. The increase in practice cannot fully be explained by an increase in the prevalence of osteoarthritis and population growth, and has been partly attributed to expansion to people with less severe symptoms. The total number of procedures performed each year now exceeds 640,000. The evidence for the benefit of total knee replacement has been based on studies without a comparison group of no total knee replacement, and so far only one randomized clinical trial has been published. Although the published literature shows large improvements of pain, physical functioning and overall quality of life following the procedure, patients included in these studies generally had severe preoperative symptoms. A number of studies have suggested, however, that up to a third of recipients of total knee replacement show no benefit, and that those with poor physical functioning before surgery may show larger improvements. Therefore, the current US patient population undergoing total knee replacement might show less significant improvement in symptoms on average as compared with a hypothetical scenario in which eligibility is limited to those with more severe symptoms. (more…)