If you are living with knee pain and have been suffering for too long, you are not alone. Research has found that almost 90% of Americans that suffer from osteoarthritis wait too long before opting for a knee replacement surgery even though it could help improve the quality of their life.
Lead investigator and an associate professor of surgery at Northwestern University's Feinberg School of Medicine, Hassan Ghomrawi, said that when people wait too long, they lose more function and they can't exercise or be active. This can leave them open to weight gain, depression, and other health issues. Also, the surgery may not be successful, according to Ghomrawi.
Ghomrawi said that there are numerous studies that have shown that patients who do surgery when their function is very deteriorated may improve quite a bit, but their improvement is still not to the average. They lag behind in optimal benefit. On the other hand, the study also found out that 25% of people who do choose to have knee surgery are getting too early, making significant risks, including potential complications and difficulties, while shouldering the cost of major surgery without getting much extra benefit in mobility.
Ghomrawi also said that there are million knee surgery procedures happening in the United States every year. Around 25% of those are premature and that is a lot of patients. Since artificial knees wear out after 20 years, early adopters are also setting themselves up for yet another knee replacement later in their life, which is usually a much more complicated surgery with a worse outcome than the original.
An objective algorithm
The study, published in the Journal of Bone and Joint Surgery, followed more than 8,000 people with symptoms of knee osteoarthritis for up to eight years. While other studies have looked at people who underwent the surgery, the study is believed to be the first to look after the timeliness of knee replacement among those who might benefit from the surgery.
The study is said to apply an objective measure to know the ideal timing of knee replacement. It used an algorithm that was first developed in Europe in 2003 and then later updated in 2014 by Virginia Commonwealth researchers who analyzed data from a smaller study of 200 people and found a third that had surgery too early.
Ghomrawi said that there are 16 combinations that were unique and that can be assigned based on knee stability, age and whether the patient has slight, moderate, intense or severe pain.
The measurement looks at the severity of the patient's osteoarthritis on X-rays, as well as how many parts of the knee are affected: the tibia or the shin bone, the femur or the thigh bone and the patella or the kneecap.
After factoring all of these elements, Ghomrawi and his colleagues assigned patients in the study into three categories, timely, delayed and premature.
The cost of premature surgery
This is not the first study to try and apply objective criteria to what has been a subjective conversation between a doctor and a patient. The UK's National Health Service commissioned a study in 2019 to see if they could apply some objective measures to the decision.
The effort is partly driven by the cost of the surgery. In the UK, the cost can range from 11,000 pounds or $14,300 to 15,000 pounds or $19,467 and a study in 2015 stated that if there are complications or the surgery must be redone, the cost can rise to 75,000 pounds or $97,313.
According to a study by Blue Cross Blue Shield, a typical knee replacement surgery in America is very expensive. It can cost between $12,000 to $70,000 depending on what part of the country you live in. And then there is the growing popularity of the surgery. In the US alone, the American Academy of Orthopedic Surgeons projects knee replacement surgeries will grow up to 189% in the next 10 years, for a projected 1.28 million procedures by 2030.
