“Using a Validated Algorithm to Judge the Appropriateness of Total Knee Arthroplasty in the United States: A Multi-Center Longitudinal Cohort Study (Riddle, et al)” recently published in Arthritis & Rheumatology about total knee replacement has lead to some news articles questioning the appropriateness of TKR. One of the study’s authors, AAHKS Second Vice President, Bill Jiranek, MD, worked with AAHKS to create this response. Members may use these as talking points:
- AAHKS commends the authors of the study, which include an AAHKS leader, for examining whether existing models of determining the appropriateness of total knee arthroplasty are adequate.
- The study applied what appears to be the best existing model: an older model developed in Spain that defines the “appropriate” patient for knee replacement as an older individual in severe pain with functional limitations (i.e., difficulty walking). The trend in US knee replacement patients is for the surgery to occur earlier, to preserve and extend an active, independent life style. Not surprisingly, applying the criteria used in the study to a modern US sample of patients showed a good number of patients in the “inappropriate” category.
- The authors concluded that the criteria need to be examined, not that large numbers of patients are needlessly undergoing knee replacement. The data showed that there were 30% who indicated mild or no pain before their surgery which tipped them into the “inappropriate” category. The data also shows that all patients, including those classified as inappropriate, ended up with similar outcome scores.
- Accurately assessing the appropriateness of knee replacement surgery is very important both in order to limit inappropriate healthcare spending and also to make sure patients who would benefit from the procedure have access to care.
- A recent study in the Journal of Bone and Joint Surgery found that knee replacement is a cost-effective treatment for patients with end-stage osteoarthritis. The savings to an individual average between $10,000 and $30,000 over a lifetime and the savings to the healthcare system add up to $12 billion dollars. For those who need it, knee replacement surgery can keep people mobile and active.
- By documenting the need for an improved assessment model, the study provides support for organizations like AAHKS that are engaged in the development of evidence based guidelines and a data-driven approach to patient care.