Total knee replacement surgery is increasingly used in the United States but there is no agreed upon criteria that determine if a person needs a total knee replacement. The first U. S. study that compared appropriateness of knee replacement surgery with a validated set of criteria was conducted by Dr. Daniel Riddle from the Department of Physical Therapy at Virginia Commonwealth University in Richmond. The study was published in the June 30, 2014, edition of the journal Arthritis & Rheumatology.
The results were based on 175 people that had undergone total knee replacements. The evaluation criteria were developed in Spain and Canada. The results indicate that 33 percent of total knee replacement procedures were inappropriate, 22 percent of these operations produced inconclusive results, and 44 percent of surgeries were classified as appropriate. The participants in the study were part of the Osteoarthritis Initiative that is designed in part to develop criteria in the United States for making the determination of total knee replacement.
The average cost of a total knee replacement procedure ranges from $40,000 to $75,000. The majority of people that receive a replacement knee are over 67 yeas of age and are covered by Medicare. The rate of total knee replacement procedures has increased by 162 percent each year over the last 15 years provided that Medicare covered the cost of the operation. The number of women that received a full knee replacement in the same time frame was 60 percent of all knee replacements.
The objective of the research is to establish a working set of criteria that meet the needs of patients that truly need a knee replacement and eliminates those operations that provide no benefit or minimal benefit. There are about 600,000 total knee replacements done in the United States every year. The minimum savings to Medicare by eliminating those procedures that are not appropriate would be $8 million each year.