Total knee replacement could be limited to most severe cases of knee osteoarthritis, according to an analysis published today.
The findings, from a US-based study, may fuel the debate in the UK about restrictions that some clinical commissioning groups are seeking to impose.
Dr Bart Ferket of the Icahn School of Medicine at Mount Sinai, New York, USA, and his team evaluated quality of life outcomes of total knee replacement on people with knee osteoarthritis using figures from two US studies, including 4,498 participants with or at high risk for knee osteoarthritis. All were aged 45 to 79 years, and were followed for nine years.
Total knee replacement showed small improvements in quality of life overall, but larger improvements for those with lower functional status at the time of the operation.
Next they carried out a cost-effectiveness analysis, which suggested that current practice is more expensive and in some cases less effective than scenarios in which total knee replacement is performed only in patients with lower physical function.
The researchers conclude: "Current practice of total knee replacement as performed in a recent US cohort of patients with knee osteoarthritis had minimal effects on quality of life.
"If the procedure were restricted to more severely affected patients, its effectiveness would rise, with practice becoming economically more attractive than its current use."
Details appear in BMJ.
They add: "Our findings emphasise the need for more research comparing total knee replacement with less expensive, more conservative interventions, particularly in patients with less severe symptoms."
At present, rates of total knee replacement are on the rise, but up to a third of patients experience chronic pain postoperatively.
Ferket, B. S. et al. Impact of total knee replacement practice: cost effectiveness analysis of data from the Osteoarthritis Initiative. BMJ 29 March 2017; doi: 10.1136/bmj.j1131 [abstract]
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