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Study: A Third of Knee Replacement Surgeries in U.S. May Be Unnecessary

Authors call for consensus on patient selection

According to a new report published online in Arthritis & Rheumatology, one-third of knee replacement surgeries may be inappropriate, based on the patients’ osteoarthritis symptoms.

Investigators at Virginia Commonwealth University used a modified version of validated appropriateness criteria to determine the prevalence rates of total knee arthroplasty (TKA) surgeries, which were classified as appropriate, inconclusive, or inappropriate. Based on prior evidence, the authors hypothesized that the prevalence of TKA surgeries classified as inappropriate would be approximately 20%.

The study looked at a variety of pre-operative data, including Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and physical function scores, radiographic findings, knee-motion and laxity measures, and age. Prevalence rates for classifications of appropriate, inconclusive, and inappropriate were calculated.

The authors examined data from 205 individuals who underwent TKA. The prevalence rates were 44.0% for classifications of appropriate; 21.7% for inconclusive classifications; and 34.3% for inappropriate classifications.

“These data support the need for consensus development of criteria for patient selection among practitioners in the U.S. treating potential TKA candidates,” the authors said. “Among the important issues, consensus development needs to address variation in patient characteristics and the relative importance of pre-operative status and subsequent outcome.”

Sources: Reuters; June 30, 2014; and Arthritis & Rheumatology; June 30, 2014.

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