Total Knee Replacement Surgery Improves Function, Reduces Long-Term Costs

Total knee replacement (TKA) dramatically improves a patient’s quality of life and significantly reduces his/her long-term treatment costs, according to a new study.

Total knee replacement is performed on people who have severe functional limitations due to traumatic injury, a systemic disorder, or osteoarthritis, a condition which destroys cartilage and joints.

More than 194,000 TKAs are done each year in the United States, and the number is expected to increase as the population ages.

Orthopaedic researchers compared the long-term cost-effectiveness of total knee replacement surgery to that of medical management (nonoperative strategy) for treatment of severe osteoarthritis of the knee, over the remaining lifetime of the patient.

“For both strategies, we calculated the patient’s estimated average time in various functional outcome states and the total direct health care costs over his/her remaining lifetime,” said Dr. Gottlob.

The four functional states are:

the person is completely able to carry on all their usual activities

the person has some discomfort or limited motion in the knee but otherwise is able to perform usual activities

the person can do little or no regular work; little or no self-care

the person is incapacitated, primarily bedridden, or wheelchair-bound, with little or no ability for self-care

Results of the study shows that patients treated nonoperatively with anti-inflammatory medications and/or supportive devices (cane, walker) would spend all of their time in the two worse functional outcome states-unable to work or incapacitated, said Dr. Gottlob.

In contrast, total knee replacement patients would spend most of their time able to perform their everyday activities.

The costs of the TKA strategy include total hospital costs (operating room costs, implant costs, nursing unit costs), physician charges, medication costs and acute rehabilitation costs, he said. “A patient gets twice as many quality years with a total knee replacement than without the surgery,” said Dr. Gottlob.

“Total knee replacement surgery is a cost-saving procedure, even for people in their 70s, 80s and 90s. These results are especially relevant for health care decision makers who wish to allocate resources, in part, on the basis of cost-effectiveness.”

Source: Ivanhoe