Total Knee Replacement Surgeries Often Inefficient Unless Used In Most Severe Cases: Study

Individuals with knee osteoarthritis often see very little improvement in quality of life following a total knee replacement, and incur unnecessary medical costs, according to the findings of a new study. 

Researchers with the Icahn School of Medicine at Mount Sinai in New York determined that knee replacement surgery is most cost effective and provides the greatest benefits for patients who have severe functionality problems, but does little to help patients whose problems are not so severe. Their findings were published in The BMJ on March 28.

The study sought to measure the quality of life impact and cost effectiveness of total knee replacement procedures. Researchers looked at data on nearly 4,500 participants ages 45-79 with a high risk of knee osteoarthritis and no previous knee replacements. They followed those patients for nine years.

According to the findings, the lifetime likelihood of undergoing a total knee replacement was about 40% for the group. However, the researchers found that if the odds of getting a knee implant was reduced to just over 10% by limiting the procedures to those with the most severe functionality problems, quality of life improvements increased, and would save an average of $6,974 per patient.

“Improvements in quality of life with total knee replacement were on average smaller than previously shown. Given its limited effectiveness in individuals with less severely affected physical function, performance of total knee replacement in these patients seems to be economically unjustifiable,” the researchers concluded. “Considerable cost savings could be made by limiting eligibility to patients with more symptomatic knee osteoarthritis.”

The findings come just days after another study warned that individuals who undergo knee replacement surgery are often charged for unnecessary procedures or treatments that do not work.

According to that study, about two-thirds of those patients first underwent a non-surgical knee treatment in the year before they had the surgery, costing a total of $43 million. Procedures included steroid injections, tramadol prescriptions, hyaluronic acid injections. physical therapy, braces, wedge insoles, opioid painkiller prescriptions and even the use of over-the-counter painkillers like Motrin and Aleve.

Researchers noted that in many cases, the treatments have already been disproven as being effective, but doctors prescribe them anyway, and some insurance companies demand that they be tried before the company shells out money for expensive knee replacement surgery. However, when the knee treatment fails, as they often do, the insurance company ends up paying for the failed procedure and the knee replacement surgery, ultimately costing more than if the patient had just had the surgery in the first place.