Total knee replacement provides minimal quality-of-life benefit for patients with less severe disability at baseline, according to new research. Thus, the treatment, as currently practiced in the United States, is not cost-effective.
“Improvements in quality of life with total knee replacement were on average smaller than previously shown,” Bart Ferket, MD, from the Icahan School of Medicine at Mount Sinai, New York City, and colleagues write. “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.”
“If the procedure were restricted to patients with more severe functional status, however, its effectiveness would rise, with practice becoming economically more attractive.”
The study, which was published online March 28 in the BMJ, analyzed data from the Osteoarthritis Initiative (OAI) database, a multicenter cohort of 4498 individuals from the general US population with or at risk for osteoarthritis of the knee. “Study participants were aged 45-79 [years] at enrolment and were tracked with repeated follow-up evaluations for nine years,” study authors state. The authors also validated their findings on a separate cohort of 2907 participants with osteoarthritis of the knee involved in the Multicenter Osteoarthritis Study (MOST). Follow-up of the MOST cohort was 2 years.
Dr Ferket and colleagues modeled the effect knee replacement had on quality of life, using the Short Form (SF)-12 physical component summary (PCS) score, the SF-12 mental component summary score, the SF-6D utility index, the Western Ontario and McMaster Universities arthritis index, and the quality-of-life subscale on the knee injury and osteoarthritis outcome score. They also assessed the effect surgery had on pain medication use out to 96 months.
Perhaps not surprisingly, those with osteoarthritis of the knee at baseline in the OAI…