(AAOS2015) Evidence from large insurance databases shows that knee replacement often quickly follows arthroscopy or injections. It would make (economic and clinical) sense to go straight to surgery, the researchers contend.
An impressive number-crunching activity using insurance claims has produced an interesting observation about end-stage knee osteoarthritis (OA). The researchers contend that many arthroscopy and injection procedures may be unnecessary, because patients often proceed to total knee replacement (TKR) within a matter of months.
Jeremiah Cohen MD and his coauthors scoured medical records from Medicare and United Health Care to see what happened beforehand to patients who ultimately had TKRs between 2007 and 2011. The search yielded almost 83,000 cases.
A statistically significant proportion of procedure charges (about 70%) traced to the year before surgery in both databases. About 8% of the Medicare patients and more than 10% of the UHC patients had arthroscopy, roughly a third of them less than six months before they had the same knee replaced.
About two-thirds of the Medicare patients and just under half of the UHC patients had knee injections before surgery, of which well more than half (62% in the case of Medicare and 74% among) UHC patients took place within six months of knee replacement.
Forgoing other procedures and opting for earlier knee replacement among patients whose knees seem to be deteriorating seems to make both economic and clinical sense, the team asserts. They are preparing the study for publication.