Today's News

Saturday, February 24, 1996

TKA improves quality of life, reduces costs, says study

Total knee arthroplasty (TKA) dramatically improves a patient's quality of life and significantly reduces his/her long-term treatment costs, according to a study presented Friday in scientific paper 114.

More than 194,000 TKAs are done each year in the United States, and the number is expected to increase as the population ages.

Orthopaedic researchers compared the long-term cost-effectiveness of total knee replacement surgery to that of medical management for treatment of severe osteoarthritis of the knee, over the remaining lifetime of the patient.

"For both strategies, we calculated the patient's estimated average time in various functional outcome states and the total direct health care costs over his/her remaining lifetime," said co-author Charles A. Gottlob, MD, of The Hughston Clinic, Columbus, Ga.

The four functional outcome states are:

I. The person is completely able to carry on all usual duties without handicaps.

II. Adequate for normal activities despite handicap of discomfort or limited motion in the knee.

III. Limited only to little or none of duties of usual occupation or self-care.

IV. Incapacitated, largely or wholly bedridden or confined to wheelchair; little or no self-care.

Results of the study shows that patients treated nonoperatively would spend all of their time in the two worse functional outcome states: 11.03 years in III; 4.08 years in IV.

In contrast, total knee replacement patients would have 11.71 years in functional outcome state I; 2.93 years in state II; 0.29 years in state III; and only 0.08 years in state IV, he said.

"We found that TKA improves function at a total health care cost of $26,103 over the life of the patient," said Dr. Gottlob.

Without surgery, the person's total health care cost will be $77,119, said Dr. Gottlob, citing significant potential costs associated with loss of independence. Custodial care in a nursing home averages $35,000 each year.

The costs of the TKA strategy include total hospital costs, physician charges, and acute rehabilitation costs, he said.

"A patient gets twice as many quality years with a total knee replacement than without the surgery," said Dr. Gottlob.

"TKA can be a cost-saving procedure for people in their '70s, '80s and '90s with severe functional limitations due to osteoarthritis of the knee. These results are especially relevant for health care decision makers who wish to allocate resources, in part, on the basis of cost-effectiveness."

Co-authors of the study are James M. Pellissier, PhD; Rowland W. Chang, MD, MPH, and, from Northwestern University Medical School, Chicago: Richard L. Wixson, MD, associate professor of orthopaedic surgery; Steven H. Stern MD, assistant professor of orthopaedic surgery; and S. David Stulberg, MD, associate professor of orthopaedic surgery.

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Last modified 27/September/1996