OPINION -- The number of Total Knee Replacement (TKR) surgeries being performed in the U.S. has tripled over the past decade and is projected to grow another 673% by 2030. Researchers have ascribed this meteoric rise to a combination of factors our society is facing -- the obesity epidemic, aging population, and unprecedented number of knee injuries in our sports-centric culture. With the average cost of TKR surgery in the U.S. being $50,000, the economic burden of these escalating surgeries is enormous.
An alarming conclusion regarding TKR surgeries was recently made in an article published in the journal of Arthritis and Rheumatology: That fewer than half of TKRs were deemed appropriate and over 30% of TKRs were deemed inappropriate. This was the first study in the U.S. to compare validated surgery criteria against patients who underwent TKR surgery. Their analysis revealed that 44% of TKRs were classified as appropriate (expected benefits > expected risks), 22% as inconclusive (benefits = risks), and a whopping 34% were deemed inappropriate (risks > benefits).
Although the benchmarks used to establish criteria for TKRs is worthy of further discussion and research, this study definitely raises concerns about over-utilization of TKRs and the need for more stringent standards in patient selection for TKR.
Another concerning trend with TKRs is that these surgeries are being performed on younger and younger patients. Almost 50% of TKRs are now being completed on individuals younger than 65. Clinical research has demonstrated that knee joint prostheses have an average lifespan of 15 years, and may not even last 10 years depending on the level of impact activities a person engages in. Since younger patients tend to engage in higher impact sports and activities, there is concern that a significant number of such people will require at least one (if not multiple) repeat surgeries – termed ‘revision’ surgeries – which are notorious for increased cost and complications.
Almost all TKRs are performed due to knee osteoarthritis (OA), which is a chronic condition characterized by loss of cartilage and joint stability. Although there is no cure for OA, there are several non-surgical treatments that effectively reduce pain, increase function, and can slow the rate of joint destruction, thus prolonging the life of the knee.
Unfortunately, people suffering with knee pain are frequently told that they need surgery, without being informed of the various non-surgical treatment options available to them. Patients either proceed directly to TKR, or if they want to avoid or delay surgery, become lost in our current medical system, being shuffled between their primary care provider, physical therapists, and orthopedic specialists. As such, there is a significant deficit in our current medical model on how to best treat patients who have disabling knee pain and who want to avoid surgery.
Reflex knee clinic was established to address this issue and to provide more treatment options for those diagnosed with OA. Reflex physicians focus on providing research-proven, non-surgical treatments for knee pain and have helped hundreds of patients get back to life and postpone or avoid TKR surgery. At Reflex, we believe in patient empowerment through education and discussion of the various treatments. We highly recommend that patients explore non-surgical treatments before committing to an invasive TKR surgery.
Full citation: "Using a Validated Algorithm to Judge the Appropriateness of Total Knee Arthroplasty in the United States: A Multi-Center Longitudinal Cohort Study." Daniel L. Riddle, William A. Jiranek and Curtis W. Hayes. Arthritis & Rheumatology; Published Online: June 30, 2014 (DOI: 10.1002/art.38685).
Editorial: "Appropriateness of Total Knee Replacement." Jeffrey N. Katz, Arthritis & Rheumatology; Published Online: June 30, 2014 (DOI: 10.1002/art.38688).
Dr. Russ Riggs is the director and owner of the Reflex knee clinic. He received his medical degree from Baylor College of Medicine in Houston, and then completed specialty training and board certification in emergency medicine. He has a passion for knee health and has undergone additional specialty training in treating various knee pathologies, along with certification in fluoroscopy, ultrasound and PRP. Reflex is a knee pain specialty clinic established three years ago with a focus on providing non-surgical treatments for knee pain and to help patients avoid or postpone surgery.
