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21-01-2020 | Osteoarthritis | News

Timely use of TKR needs improvement

Laura Cowen

medwireNews: Both premature and delayed use of total knee replacement (TKR) are common among people with knee osteoarthritis, US researchers report.

The analysis of pooled data from two multicenter cohort studies showed that nine out of every 10 knees deemed potentially appropriate for replacement had not undergone surgery within 2 years, while more than a quarter of the knees replaced were classified as premature and likely inappropriate for this procedure.

“With nearly 1,000,000 total knee replacements being performed in the U.S. each year the present study provides important impetus for future efforts directed at measuring and improving timely utilization of total knee replacement,” Hassan Ghomrawi (Northwestern University, Chicago, Illinois) and co-investigators remark.

The study included data for 3417 knees (from 2313 individuals), 3123 of which were considered to be potentially appropriate for TKR.

During up to 8 years of follow-up, 1114 TKRs were performed. Among these were 290 (26.0%) knees that were replaced within a timely manner, ie, within 2 years of the procedure becoming potentially appropriate, representing just 9.3% of the knees classified as potentially appropriate for replacement.

The remaining 2833 knees were not replaced, despite being classified as potentially appropriate for the procedure, thus comprising 90.7% of knees in this category.

Furthermore, among the knees in the “potentially appropriate but not replaced” group, 42.5% had severe symptoms, defined as a WOMAC score of 34 or above.

There were also 294 (26.4%) knees that were replaced despite being considered “likely inappropriate” for the procedure and were classified as premature.

The researchers investigated factors associated with untimely TKR and found that Black people were a significant 2.8 times more likely to be classified as potentially appropriate for, but not undergo, TKR than White people.

In addition, people who were overweight or obese, had depressive symptoms, or were over 55 years of age had a lower likelihood for premature surgery than their normal weight, non-depressed, or younger counterparts, respectively, with odds ratios ranging from 0.31 to 0.56.

Writing in the Journal of Bone & Joint Surgery, Ghomrawi and co-authors say their study suggests that “[m]ore refined and contemporaneous appropriateness criteria are needed to more accurately assess total knee replacement utilization in the U.S.”

They add: “It is our hope that the findings provided in the present report will help to catalyze the development of [such] criteria.”

medwireNews is an independent medical news service provided by Springer Healthcare. © 2020 Springer Healthcare part of the Springer Nature group

J Bone Joint Surg Am 2020; doi:10.2106/JBJS.19.00432

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