One-third of total knee replacements may be unnecessary

Within the discussion on health care reform, many people bring up unnecessary medical procedures as one of the biggest sources of wasted money in the medical industry. Whether doctors order too many tests or patients insist on them, hospitals are performing procedures that do not address real conditions.

This extends to orthopedic surgery as well. According to a recent study conducted by researchers at Virginia Commonwealth University and Boston-based Brigham and Women's Hospital and published in the journal Arthritis & Rheumatology, nearly one-third of all total knee replacements conducted in the U.S. may be unnecessary and inappropriate. Orthopedic surgeons may be too overzealous about performing the operation, especially when other treatments are available.

Performing the wrong procedure
According to the U.S. Centers for Disease Control and Prevention, 719,000 total knee replacements are performed each year. Between 1991 and 2010, the number of TKR operations grew by 162 percent, leading some critics to question if the procedure was only being used in appropriate cases.

The Arthritis & Rheumatology study investigated the data on 205 TKR patients and, based on their outcomes, categorized their TKR operations as either "appropriate," "inconclusive" or "inappropriate." The researchers used a combination of the Western Ontario and McMaster Universities Arthritis Index and a new classification system developed in Spain as their way to gauge pre- and post-operative patient information such as symptomatic pain, knee mobility and age.

The findings indicated that of all the TKR procedures conducted among the 205 patients, only 44 percent were deemed appropriate. Of the remaining operations, 22 percent were inconclusive and 34 percent were classified as inappropriate.

"Our finding that one-third of knee replacements were inappropriate was higher than expected and linked to variation in knee pain [osteoarthritis] severity and functional loss," Daniel Riddle, P.T., Ph.D., assistant chair of the department of physical therapy at VCU and lead author of the study, said in a statement. "These data highlight the need to develop patient selection criteria in the U.S."

Patients who did not need TKR operations may be subjected to unnecessary hardship during rehabilitation. Indeed, artificial joints may not offer the mobility of natural ones, even among the newest models.

The study admitted that differences in patients' body composition and health history make judging applicability for a TKR procedure a difficult task. Riddle and his colleagues hoped that their findings would prompt the creation of a more regimented database for the use of TKRs on patients.