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Knee replacement: last resort only

Contemplating joint replacement surgery for that dodgy knee? You might want to think twice, according to US researchers after their study showed the procedure didn’t necessarily do much to improve quality of life.

The study, published in the BMJ (1) analysed data from the Osteoarthritis Initiative which involved almost 4500 people (aged 45-79 years) with severe knee osteoarthritis who were followed for nine years.

Overall the researchers found total knee replacement had a minimal benefit on quality of life, and, using US health care costings, could not be considered cost -effective.

Their findings confirm previous research which had estimated as many as a third of patients still experienced chronic pain after having their knee replaced.

But the news isn’t all bad. The BMJ study also showed, the worse the knee was prior to the operation in terms of pain and disability the greater the benefit was likely to be following surgery.

“Quality of life outcomes generally improve after total knee replacement, with small effects becoming larger with decreasing preoperative physical functioning,” the study authors said.

If only the people with the most severe osteoarthritis underwent surgery then basically, the operation became more worthwhile in terms of quality of life and value for money, they advised.

The conclusion is very similar to that from a UK study (2) published earlier this year which found that up to a third of people who underwent a total knee replacement before the age of 70 needed to have revision surgery.

These two studies are part of a growing body of evidence that knee replacement surgery, particularly for osteoarthritis should only be considered when all other treatment options have been exhausted. This may have major implications for Australia where more than 54,000 total knee replacements are done each year, and increasingly in younger people.

Ref:

  1. BMJ online http://www.bmj.com/content/356/bmj.j1039 (embargoed until evening Tuesday 28.3)
  2. Lancet online http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)30059-4/abstract