Marked Variability Seen in Total Knee Arthroplasty Indications
(HealthDay News) – There is considerable variability associated with total knee arthroplasty (TKA) recommendations, according to a report published in the May issue of Pain Medicine News.
Liana Fraenkel, MD, MPH, from the Yale School of Medicine in New Haven, CT, and colleagues surveyed 406 orthopedic surgeons and 494 rheumatologists to examine whether they recommended TKA in various scenarios involving a 62-year-old patient with knee osteoarthritis and moderate pain.
The researchers found that for a patient described as having mild radiographic osteoarthritis and moderate pain, the proportion of physicians who recommended TKA ranged from 30–55%. For a patient with moderate radiographic osteoarthritis and moderate pain, the proportion recommending TKA ranged from 39–71%. The proportion who recommended TKA varied significantly according to gender (59% for a male patient compared with 44% for a female patient). Compared with European surgeons (34%), U.S. surgeons were more likely to recommend TKA (52%). Rheumatologists and surgeons aged 40 years or younger were significantly more likely to recommend TKA (61% vs. 46% for rheumatologists; 60% vs. 48% for surgeons). Rheumatologists who were academics were significantly more likely to recommend TKA (63% vs. 48%). Rheumatologists were also significantly more likely to recommend TKA for patients with moderate vs. mild X-ray changes (60% vs. 41%), and to retirees vs. working people (56% vs. 42%).
"Studies are needed to determine appropriateness criteria for TKA in order to reduce the unwarranted variability associated with TKA," Fraenkel said in a statement.