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Total Knee Arthroplasty Among Medicare Beneficiaries

Approximately 600,000 total knee arthroplasties (TKA) are performed each year in the United States, costing about $15,000 per procedure. “TKA has been shown to markedly improve health-related quality of life and functional status and is highly cost-effective,” says Peter Cram, MD, MBA. “The number of TKA procedures in the U.S. has been increasing in recent years due to the surgery’s effectiveness for reducing pain and improving function for our aging population.” This trend, however, may further strain the government, insurers, and patients struggling with the ever-increasing healthcare spending. Despite the important role of TKA in healthcare utilization and costs, few analyses have evaluated recent trends in using these surgeries as well as outcomes associated with them. In an issue of JAMA, Dr. Cram and colleagues had a study published that evaluated longitudinal trends in primary and revision TKA among Medicare enrollees. The analysis involved more than 3 million Medicare patients who underwent primary TKA and over 300,000 who underwent revision TKA. A secondary objective was to examine patient and hospital factors that increased risk for hospital readmission. Significant Increases in TKA The number of Americans undergoing primary and revision TKA jumped substantially from 1991 to 2010, according to findings from Dr. Cram’s study. The volume of initial knee replacements and revisions more than doubled during the study period. Among Medicare beneficiaries, annual primary TKA volume increased by 161.5%, rising from 93,230 to 243,802. Per capita utilization increased by 99.2%, increasing from 31.2 procedures per 10,000 Medicare enrollees in 1991 to 62.1 procedures per 10,000 in 2010. Revision TKA volume increased by 105.9%, rising from 9,650 to 19,871. Per capita...

The Impact of Decision Aids in Hip & Knee Surgery

Investigators from Washington suggest using patient decision aids appears to reduce rates of elective surgery and lowers cost for some health conditions for which treatment decisions are highly sensitive to patient and physician preferences. Decisions aids were associated with 26% fewer hip replacements and 38% fewer knee replacements. They lowered costs between 12% and 20% over 6 months. Abstract: Health Affairs, September...

The Changing Tide of Knee Arthroscopy in the U.S.

CDC data show that knee arthroscopy is one of the most frequently performed ambulatory orthopedic procedures in the United States. The surgery is now primarily used for the removal of loose bodies, debridement of meniscal tears, debridement and recontouring of cartilage flaps, arthroscopically assisted ligament reconstruction and meniscal transplantation, and synovectomy. In the early 1980s, there was a shift toward performing some surgical procedures on an outpatient basis for a variety of reasons. “Advances in anesthesia and surgical techniques, financial incentives to providers and patients, and enhancements in postoperative pain management were all factors that led to this shift,” explains Richard A. Marder, MD. “It’s well understood that the number of ambulatory surgical procedures is increasing, but there has been little study exploring the frequency and magnitude of these procedures occurring in outpatient settings in the U.S.” Significant 10-Year Trends In the June 1, 2011 Journal of Bone and Joint Surgery, Sunny H. Kim, PhD, Jose Bosque, MD, John P. Meehan, MD, Amir Jamali, MD, and Dr. Marder had a study published that described the changes in demographics and utilization of knee arthroscopy in ambulatory settings between 1996 and 2006 in the U.S. The investigation, which analyzed CDC data from the National Survey of Ambulatory Surgery, also sought out to determine the most common reasons for knee arthroscopy over the past decade. “Our analysis revealed several interesting trends,” says Dr. Marder. “First, between 1996 and 2006, the number of knee arthroscopies increased by 49% (Table 1). The increase in knee arthroscopy procedures was much steeper than the growth of the U.S. population during the same period.” “Clinicians should continue to...
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