Study: Knee replacement surgeries for OA patients less effective, more costly than thought

Knee replacement surgeries for patients with osteoarthritis provide minimal improvements in quality of life and are economically unattractive, according to a study released this week.

Results from the study was published yesterday in The BMJ.

Data from the study indicated that while the procedure was inefficient for patients with osteoarthritis, its effectiveness would rise if offered only to patients with severe symptoms. Such a shift would also improve the economic attractiveness of the procedure.

“Our findings show opportunity for optimizing delivery of total knee replacement in a cost-effective way, finding the patients who will benefit the most, delivering the treatment at the correct point in their disease progression, and optimizing the cost so we can deliver the benefit to all who need it,” study co-author Madhu Mazumdar of the Icahn School of Medicine at Mount Sinai said in a prepared statement.

In the study, researchers aimed to evaluate the impact of total knee replacement procedures on quality of life for patients with knee osteoarthritis, as well as to examine the differences in lifetime costs and quality adjusted life years in relation to the level of symptoms.

Data came from 2 US cohort studies, including a total of 7,405 patients, with 4,498 having had follow-ups through 9 years, while 2,907 had follow-ups for 2 years. Quality of life was recorded using an SF-12 measurement, as well as osteoarthritis-specific quality of life scores.

Results indicated a small improvement in quality of life scores, with a more significant improvement in patients with lower pre-surgery physical scores.

Data from a cost effectiveness analysis indicated that current practices are more expensive, and sometimes less effective, compared to scenarios where total knee replacements are limited to patients with lower physical function.

“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. Considerable cost savings could be made by limiting eligibility to patients with more symptomatic knee osteoarthritis. Our findings emphasize the need for more research comparing total knee replacement with less expensive, more conservative interventions, particularly in patients with less severe symptoms,” study lead author Dr. Bart Ferket of the Icahn School of Medicine at Mount Sinai said in a press release.

“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. Considerable cost savings could be made by limiting eligibility to patients with more symptomatic knee osteoarthritis. Our findings emphasize the need for more research comparing total knee replacement with less expensive, more conservative interventions, particularly in patients with less severe symptoms,” study authors wrote.

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