If their knee pain is not helped by physical therapy or drugs, more and more seniors are deciding to have artificial joints implanted. A study by the American Medical Association, reported by Quinn Korzeniecki in Medicare News – Medicare Costs revealed that more than 3.6 million Medicare beneficiaries over the age of 65 received artificial knees between 1991 and 2010.
Rush Is on to Replace Knees
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In 2010, over 243, 802 Medicare recipients had first time knee replacement surgery or else underwent surgery to fix previous replacements. The rate of first time surgeries doubled and the rate of re-dos increased by nearly 60% over this 20-year period.
Most patients for knee replacement surgery have been in their mid-70s. One reason for the increased rate of knee surgery is the fact that more people are aging in somewhat better health than in past years and want to maintain their mobility. A second driver is the increasing rate of obesity that can lead to arthritis.
Korzeniecki reports that The Centers for Disease Control and Prevention estimates that 35.7%, or over one-third of U.S. adults, are obese. In 2010, the rate of obese older patients receiving knee replacements accounted for 12% of total knee replacement procedures—up from 4% in 1991. During this time, the proportion of knee replacement patients with diabetes or other underlying health problems doubled.
Unfortunately many first time recipients of artificial knees require a follow-up surgery. The number of revisions increased from 9, 650 patients a year in 1991 to 19, 871 in 2010, according to Korzeniecki. This means that as many as 10% of patients who have knee replacement surgery return for a later revision procedure.
If the cost to Medicare of each knee replacement surgery is estimated to be $15, 000, these surgeries cost the United States health care system around $9 billion annually. In comparison, total Medicare spending in 2011 amounted to $550 billion. Based on the trend of increasing surgeries over the past couple of decades, researchers estimate that by 2030 the demand for knee replacement surgeries may be as high as 3.48 million a year.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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