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Up To A Third Of Knee Replacements Pack Pain And Regret | Kaiser Health News

A knee replacement costs about $31,000. “The 723,000 knee replacements performed in 2014 cost patients, insurers and taxpayers more than $40 billion. Those costs are projected to surge as the nation ages and grapples with the effects of the obesity epidemic, and an aging population.

Think about all this in the context of the promises being made for Medicare for All. Do you think it can be business as usual? Do you think when it comes to many procedures there won’t be oversight and medical necessity review?

Research suggests that up to one-third of those who have knees replaced continue to experience chronic pain, while 1 in 5 are dissatisfied with the results. A study published last year in the BMJ found that knee replacement had “minimal effects on quality of life,” especially for patients with less severe arthritis.

One-third of patients who undergo knee replacement may not even be appropriate candidates for the procedure, because their arthritis symptoms aren’t severe enough to merit aggressive intervention, according to a 2014 study in Arthritis & Rheumatology.

“We do too many knee replacements,” said Dr. James Rickert, president of the Society for Patient Centered Orthopedics, which advocates for affordable health care, in an interview. “People will argue about the exact amount. But hardly anyone would argue that we don’t do too many.”

Although Americans are aging and getting heavier, those factors alone don’t explain the explosive growth in knee replacement. The increase may be fueled by a higher rate of injuries among younger patients and doctors’ greater willingness to operate on younger people, such as those in their 50s and early 60s, said Rickert, an orthopedic surgeon in Bedford, Ind. That shift has occurred because new implants can last longer — perhaps 20 years — before wearing out.

Source: Up To A Third Of Knee Replacements Pack Pain And Regret | Kaiser Health News

3 replies »

  1. When are symptoms severe enough to warrant knee replacement? The article does not mention any criteria. Lack of movement of the knee joint? Level of pain, which is inherently subjective? Where did the figure “up to one third” come from? Based on what?

    The issue is legitimate of course. But it is disappointing that the figure thrown out as to how many replacements are “unnecessary”is not tied to any definition of what is considered necessary.

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  2. You are 100% correct. Having lived with a wife that had both knees done she no longer eats aspirin to reduce the pain. We would tour Europe and she would stay on the boat or sit on the bench and wait for me. Doctors and hospitals are no different than the auto body business up the street. They see money to be made.

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  3. What a timely post. I have been wondering when I should demand surgery for my knee. I been wondering how bad my arthritis symptoms have to be for an “intervention”. The more I walk, the more I exercise, the greater the pain and the less I do which is making me become sedentary. I am not addicted to opioids yet, but at what level of pain do I have to have before I get knee surgery?

    My 54-year-old brother who has had 4 knee operations told me not to mess around and don’t wait, life is so much better after getting surgery. He told me that he is down to one Aleve a day. My mother-in-law has her knee replaced in her 70’s because she couldn’t get up out of a chair. It changed her life for the better and she still gets around quite well at 91. I called that a big improvement in her quality of life.

    Do I believe that too many surgeries are being done of which some are not required? Yes. Do I believe that 1/3 still have chronic pain? Yes I do, but what was their level of pain before the surgery? Was this study done to save insurance companies money? Do I believe that people demand surgery just to have “something done” for their knee and do they have overly high expectations? Yes I do.

    This study implies that 20% to 33% that knee surgery didn’t work and maybe I should hold off on getting knee surgery. If this study was in the hands of a third party “approving” bureaucrats, maybe they will just deny 1/3 of the surgeries. The study concludes that “If the procedure were restricted to more severely affected patients, its effectiveness would rise, with practice becoming economically more attractive that its current use”. To me that is like saying that a small roof leak is not economically attractive until the whole roof needs replacing. Of course if you wait until it is almost too late the outcomes will be great. But how many other health issues will I get from restricting my movements and not exercising to avoid pain?

    It looks like this study was only focused on money and that will be the future of how medical care will rationed.

    https://www.bmj.com/content/356/bmj.j1131

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