Total knee arthroplasty (TKA; knee replacement) surgeries have increased among Medicare enrollees as well as rise in per capita utilization, reports study published in JAMA. Total knee arthroplastyThere has also been a decrease in hospital length of stay for TKA, but increased hospital readmission rates and increased rates of infectious complications.
"Total knee arthroplasty is a common and safe procedure typically performed for relief of symptoms in patients with severe knee arthritis. Available data suggest that approximately 600,000 TKA procedures are performed annually in the United States at a cost of approximately $15,000 per procedure ($9 billion per year in aggregate)," according to background information in the article. Total knee arthroplasty is one of the most common and costly surgical procedures performed in the United States. "Despite the clinical and economic policy importance of TKA, there are few analyses evaluating recent trends over time in use of and outcomes associated with TKA."
Peter Cram, M.D., M.B.A., of the University of Iowa Carver College of Medicine, Iowa City, Iowa, and colleagues conducted a study to evaluate trends in primary and revision TKA volume, per capita utilization, and outcomes in the U.S. Medicare population for the time period between 1991 and 2010. The analysis included 3,271,851 patients (age 65 years or older) who underwent primary TKA and 318,563 who underwent revision TKA identified in Medicare Part A data files.
"Trends in discharge disposition after revision TKA demonstrated a similar pattern to that which was observed for primary TKA, a decline in discharges to home or inpatient rehabilitation and an increase in discharge to skilled care and outpatient rehabilitation," the authors write.
The researchers add that for revision TKA, a decrease in hospital LOS was accompanied by an increase in all-cause 30-day readmission from 6.1 percent to 8.9 percent and an increase in readmission for wound infection from 1.4 percent to 3.0 percent.
"These figures suggest that growth in primary and revision TKA volume is being driven by both an increase in the number of Medicare enrollees and an increase in per capita arthroplasty utilization," the authors write. "This growth is likely driven by a combination of factors including an expansion in the types of patients considered likely to benefit from TKA, an aging population, and an increasing prevalence of certain conditions that predispose patients to osteoarthritis, most notably obesity."
"The growth in TKA should prompt consideration of whether too many (or too few) of these procedures are being performed both in aggregate and among key patient subgroups defined by race, sex, or age."