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...