Healthcare News & Insights

Are U.S. surgeons performing unnecessary knee replacements?

The number of total knee replacement surgeries has more than doubled between 1991 and 2010. So the question is: Did all these people really need knee replacement surgery or are we overusing the procedure? 

461783085It’s hard to answer that question, because it’s hard to prove the surgery wasn’t required.

Reason: Pain is often the main driver of the decision to proceed with the surgery, and everyone perceives pain differently.

However, Dr. Daniel Riddle, from Virginia Commonwealth University in Richmond, and his team were determined to find out, reported Reuters Health.

Analyzed data

They examined data from a U.S. study of about 4,800 people with knee osteoarthritis or at a high risk of the condition, 205 of which had total knee replacement surgery.

From their analysis of the data, the researchers determined if the surgeries were appropriate, inappropriate or inconclusive. They used the criteria for knee replacement developed by Dr. Antonio Escobar of Hospital de Basurto in Vizcaya, Spain, and his colleagues as the basis for their decisions. The criteria was based on factors such as range of motion, pain and arthritis severity.

Dr. Riddle and his team were shocked to find that 34% of the surgeries were deemed to be inappropriate — they were expecting a number much closer to 20% based on prior studies.

Other findings: 44% of the surgeries were deemed appropriate and 22% were inconclusive. Patients in the inconclusive category included people who had severe symptoms but were younger than 55, or had less joint damage and normal mobility.

Excessive surgeries?

So the million dollar question is: Are U.S. surgeons performing knee replacement surgeries when patients don’t really need them?

To answer that question, more research is needed.

“The scientific content and the standard at the time [this system] was developed is clearly different from that in the U.S. in 2014,” said Dr. Riddle.

According to the study authors, research now need to focus on developing a system to separate inappropriate from appropriate knee replacements based on U.S. patients.

“The key issues, in addition to a reasonably healthy medical status, are the extent of pain, extent of compromised function and extent of knee osteoarthritis,” said Dr. Riddle. “We have very good prognostic data now and we know that persons with high levels of psychological distress, minor knee osteoarthritis, serious [other health conditions] and multiple joint arthritic disease are at greatest risk of poor outcomes.”



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