Revision Estimates Haunt TKRs

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Bilione W. Young • Tue, Feb 21st, 2012

While it is great that over a million and a half Americans have regained their mobility through knee replacement (TKR) surgery, the future financial implications of those surgeries may be worrisome. Reason? Those new knees are in adults younger than 70 meaning the recipients are “likely to live long enough to be at risk for revision,” said Elena Losina, Ph.D., of Boston University, in the presentation of her study at the American Academy of Orthopaedic Surgeons (AAOS) annual meeting.

As reported February 13 by John Gever of MedPage Today, Losina developed her TKR incidence data from the Multicenter Osteoarthritis Study and the Osteoarthritis Initiative and extrapolated it to the entire population on the basis of osteoarthritis occurrences established in the National Health and Nutrition examination survey. She fed these numbers into a system that uses simulations to estimate TKR prevalence by age and gender, the progression of symptomatic osteoarthritis, and the likelihood of revision.

Among her finding was that 2% of women and more than 1% of men in their 50s already have received one or more artificial knees. When she investigated the ages from 60 to 69, she found that 3% of men and 4% of women have had knee replacement surgery.

When Losina and her colleagues included estimates of the progression of osteoarthritis and demographic trends they found that the lifetime risk of knee replacement is about 10% for women and 7% for men. Adding to the estimated cost is the expectation that about 1% of men and 2% of women will have had multiple procedures on the same joint by the time they die.

Gever quotes Losina as noting that the estimates suggest that knee replacement “is considerably more prevalent than rheumatoid arthritis and nearly as prevalent as congestive heart failure.” Because knee replacements are being performed more commonly in the middle-aged, there is an “urgent need for studying longer-term outcomes in younger persons undergoing TKR,” she said.

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