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Large Joints Feature

Source: Wikipedia Commons and Bruce Blaus

New Study: Better TKA Patient Selection Needed

Tracey Romero • Tue, April 4th, 2017

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Total knee replacement does not offer the same level of benefit to patients with less severe symptoms of knee osteoarthritis as it does patients with more aggravated symptoms, according to a new study from Mount Sinai Hospital published in the March 2017 issue of British Medical Journal (BMJ). Therefore researchers suggest that more restrictive total knee replacement is needed in the U.S.

Bart S. Ferket, M.D, Ph.D., assistant professor for the department of population health science and policy at the Icahn School of Medicine, Mount Sinai Hospital in New York and colleagues used data from 4,498 participants of the Osteoarthritis Initiative (OAI) and 2,907 patients in the Multicenter Osteoarthritis Study (MOST) to evaluate whether the effectiveness of total knee replacement for patients with knee osteoarthritis varies depending on the severity of symptoms.

Ferket and colleagues looked at differences in lifetime costs and quality adjusted life years, and found that while quality of life outcomes did generally improve, the effect was still small. The greatest improvements were found in patients who had more severe symptoms prior to surgery. According to their cost-effective analysis, it would more effective and less expensive to only perform total knee replacement on patients with lower physical function.

Ferket told OTW that more conservative treatment options should be tried first for patients with less severe symptoms.

He said, “Recent evidence-based recommendations such as from the American Academy of Orthopaedic Surgeons consistently strongly recommend exercise programs for individuals with knee osteoarthritis as well as weight loss programs for overweight individuals with knee osteoarthritis. Together with patient education and safe first-line pain medication like acetaminophen and/or topical nonsteroidal anti-inflammatory drugs this is the basic treatment strategy.”

He also recommended supportive shock-absorbing footwear, local hot and cold compresses, transcutaneous electrical nerve stimulation, intra-articular corticosteroid injections, and adjunctive braces and assistive devices.

“Almost all osteoarthritis experts agree on the fact that patients should be offered these interventions in an optimal way before surgery is considered, but in reality we still see in many cases that conservative treatment has not been offered optimally before surgery is done,” he added.

According to Ferket, future research should focus on “better healthcare delivery of conservative treatment programs” like the Good Life with osteoarthritis in Denmark Initiative.

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