One Third of Knee Replacements Inappropriate

Replacement not always necessary.

One Third of Knee Replacements Inappropriate New research reports that more than one third of total knee replacements in the U.S. were classified as ‰ÛÏinappropriate‰Û. The study, published in Arthritis & Rheumatology, a journal of the American College of Rheumatology (ACR), highlights the need for consensus on patient selection criteria among U.S. medical professionals treating those with the potential need of knee replacement surgery. The Agency for Healthcare Research and Quality reports more than 600,000 knee replacements are performed in the U.S. each year. In the past 15 years, the use of total knee arthroplasty has grown significantly, with studies showing an annual volume increase of 162% in Medicare-covered knee replacement surgeries between 1991 and 2010. Some experts believe the growth is due to use of an effective procedure, while others contend there is over-use of the surgery that relies on subjective criteria. The present study led by Dr. Daniel Riddle from the Department of Physical Therapy at Virginia Commonwealth University in Richmond, examined the criteria used to determine the appropriateness of total knee arthroplasties. There were 175 subjects who underwent total knee replacement surgery, and were classified as appropriate, inconclusive, or inappropriate. The mean age of knee replacement patients was 67 years and 60% of the group was female. Analyses show that 44% of surgeries were classified as appropriate, 22% as inconclusive, and 34% deemed inappropriate. The characteristics of patients undergoing surgery were varied. ‰ÛÏOur finding that one third of knee replacements were inappropriate was higher than expected. These data highlight the need to develop patient selection criteria in the U.S.,‰Û concludes Dr. Riddle. Dr. Jeffery Katz from the Orthopedic and Arthritis Center for Outcomes Research at Brigham and Women‰Ûªs Hospital in Boston, Mass. calls for an update to the criteria used to determine which patients are good candidates for total knee arthroplasty. For the consumer, it’s simple, question your doctor. We are still in a fee for service environment so the more procedures providers do, the more they make. And that does not always translate to better quality for you.