Which is better—total knee replacement or a partial? A new study by Weill Cornell Medical College and Hospital for Special Surgery suggests the latter. The study, published in the Journal of Bone and Joint Surgery, found that partial knee—also known as unicompartmental—replacements provide greater economic value to patients over the age of 65 compared to total knee replacements. Investigators found that these patients are less likely to face surgical complications and require less physical therapy than do those who undergo total knee replacement surgery.
The investigators analyzed data from the Swedish Knee Arthroplasty Register. They found that the cost of care for patients undergoing partial knee replacement surgery could be substantially less than for those having total knee replacements over the course of the patients’ lifetimes. Costs associated with partial knee replacement surgery ranged from $35, 000 for an 85-year-old patient to $46, 600 for a 45-year-old patient. The costs for a total knee replacement ranged from $42, 000 to $47, 600.
Researchers estimate that 10% to 21% of total knee replacement patients qualify for partial knee replacement. The U.S. healthcare system, including patients, providers and insurers, would save $56 million if just 10% of older patients undergo the procedure in 2015. If 21% of these patients underwent the procedure, the healthcare system could bank more than $330 million.
“This is an environment that’s increasingly cost sensitive, and we’re always looking to minimize cost of our healthcare system, ” Lead author Hassan Ghomrawi, M.D., said. “Here’s a procedure (total knee replacement) that’s going to be utllized a lot in the future, so we’re evaluating an alternative to what’s conventionally done for these patients that could save us some money and, hopefully, produce similar or better results.”
Partial knee replacements have traditionally been controversial due to the higher risk of needing a revision surgery. Nevertheless, physicians and researchers have found that this partial procedure offers substantial benefits. It is minimally invasive and results in less blood loss and trauma than do total knee replacements. It is associated with fewer medical and surgical complications. Patients’ reconstructed knees tend to have a better range of motion following a shorter stint in physical therapy.
Ghomrawi, an assistant professor of healthcare policy and research at Weill Cornell and a research scientist at Hospital for Special Surgery, said, “With a unicompartmental knee replacement, you’re more likely to return to work earlier and have better function compared to total knee replacement, which requires more rehabilitation and has more complications. This is one of the situations where we do a cost-effectiveness analysis to try to see which one is better over the lifetime of the patient.”
