Knee Replacement Patients Overcharged For Unnecessary Procedures: Study

A new study warns that individuals who undergo knee replacement surgery are often charged for unnecessary procedures or treatments that do not work. 

In a study presented at the meeting of the American Academy of Orthopaedic Surgeons, and published in the March issue of the Journal of Arthroplasty, researchers from the University of Iowa Hospitals and Clinics warned that millions of dollars are spent on unnecessary or ineffective treatments related to knee problems.

Much of the waste comes in the form of procedures and treatments designed to avoid actual surgeries, according to the report. Researchers looked at data from a Humana database involving more than 86,000 patients who underwent total knee arthroplasty (TKA) from 2007 to 2015.

According to the findings, 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.

One such procedure involves hyaluronic acid injections, which are supposed to relieve knee pain, particularly from osteoarthritis (OA). However, the researchers pointed out that the injections have been shown not to help the majority of patients. Despite that, the cost of hyaluronic acid injections account for 29% of medical costs they tracked in the study.

Researchers found only three of the eight treatments studied that appeared to be effective: physical therapy, tramadol and over-the-counter painkillers. Those three procedures only represent 12.2% of non inpatient knee procedure costs, however. The rest went to procedures that were not recommended and not proven to be effective.

“In the year prior to TKA, over half of the non-inpatient costs associated with knee OA are from injections, therapy, prosthetics, and prescriptions. Approximately 30% of this is due to HA injections alone,” the researchers concluded. “If only interventions recommend by the (Clinical Practice Guidelines) are utilized then costs associated with knee OA could be decreased by 45%.”