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Is Knee Replacement Surgery Appropriate?

How many of your friends or family members do you know have had knee surgery? The number of Total Knee Replacement (TKR) surgeries being performed in the U.S. has tripled over the past decade and is projected to grow another 673% by 2030! Researchers have ascribed this meteoric rise to a combination of factors our society is facing:

  • the obesity epidemic
  • an aging population
  • an unprecedented number of knee injuries in our sports-centric culture.

Recently, an alarming conclusion regarding TKR surgeries was made in an article published in the journal of Arthritis and Rheumatology:

 Fewer than half of total knee replacement surgeries were deemed appropriate and, even worse, over 30% of TKRs were deemed inappropriate. This was the first study in the U.S. to compare validated surgery criteria against patients who underwent TKR surgery. What do they mean by “appropriate” in this scenario? An “appropriate” knee replacement surgery means that the expected benefits after surgery outweighed the expected risks of having the procedure. They found that in 34% of the operations preformed the risks outweighed the benefits, and in the remaining 22% of patients the risks of surgery and benefits equaled each other out. Which means the benefits outweighed the risks in only 44% of patients. If you’re not a gambling person, this is starting to sound a bit risky, even if it’s your only treatment option.

Although the benchmarks used to establish criteria for TKRs is worthy of further discussion and research, this study definitely raises concerns about over-utilization of TKRs and the need for more stringent standards in patient selection for TKR. Instead of asking whether or not they CAN operate, the question should be whether or not they SHOULD.

Another concerning trend with this surgery is that they are being performed on younger and younger patients. Almost 50% of TKRs are now being completed on individuals younger than 65.   Clinical research has demonstrated that knee joint prostheses have an average lifespan of 15 years, and may not even last 10 years depending on the level of impact activities a person engages in. Since younger patients tend to engage in higher impact sports and activities, there is concern that a significant number these types of patients will require at least one (if not multiple) repeat surgeries – termed ‘revision’ surgeries – which are notorious for increased cost and complications.

 

Get Informed – There are Other Options:

At Reflex, we believe in patient empowerment through education and discussion of the various treatments. We highly recommend that patients explore non-surgical treatments before committing to an invasive TKR surgery.

Almost all TKRs are performed due to knee osteoarthritis (OA), which is a chronic condition characterized by loss of cartilage and joint stability. Although there is no cure for OA, there are several non-surgical treatments that effectively reduce pain, increase function, and can slow the rate of joint destruction, thus prolonging the life of the knee.

Unfortunately, people suffering with knee pain are frequently told that they need surgery, without being informed of the various non-surgical treatment options available to them. Patients either proceed directly to TKR, or if they want to avoid or delay surgery, become lost in our current medical system, being shuffled between their primary care provider, physical therapists, and orthopedic specialists. As such, there is a significant deficit in our current medical model on how to best treat patients who have disabling knee pain and who want to avoid surgery. You can do yourself a favor by doing your own research, getting a second option, and making sure you know what all your options are before going under the knife.