Study: 1/3 of knee replacements are questionable
June 30th, 2014
03:34 PM ET

Study: 1/3 of knee replacements are questionable

Whether to replace aging knees can be a tough decision. More than 650,000 Americans underwent total knee replacement surgery last year, but a new paper from researchers at Virginia Commonwealth University suggests that a third of those were not “appropriate,” based on standard medical criteria.

The study authors analyzed 175 cases, looking at imaging tests to find the degree of arthritis, as well as each patient’s age and reported pain level. Only 44% of the operations were rated “appropriate.” Thirty-four percent were “inappropriate,” while 22% were inconclusive.

But appropriateness is in the eye of the beholder, says Dr. Jeffery Katz, an orthopedic surgeon at Brigham and Women’s Hospital in Boston. When the current criteria were developed in the late 1990s, knee replacement “was considered a treatment of last resort,” Katz writes in an editorial published alongside the study in the Journal of Arthritis and Rheumatism. Today, many are being done in relatively healthy people in their 50s and 60s.

Is fake knee surgery as good as the real thing?

What’s more, some doctors say, safety and effectiveness have improved significantly since the criteria were first developed.

“Knee replacement is very effective,” says Dr. Joshua Jacobs, an orthopedic surgeon at Rush University Medical Center and a former president of the American Academy of Orthopaedic Surgeons. “The increasing demand is a marker of how well it improves function and relieves pain.”

Whether knee replacement should be used to preserve function and not just restore it “is worthy of debate,” says Dr. Daniel Riddle, the paper’s lead author and a professor in the Department of Physical Therapy and Orthopedic Surgery at VCU. “Some patients play nine holes of golf and they want to play 18, and knee replacement can help with that.”

He says the real question is whether it’s worth the cost – which typically runs between $20,000 and $40,000 – and the potential risks.

A knee replacement is major surgery; potential dangers include infection, deep vein thrombosis and pulmonary embolism. There’s even a non-negligible chance of death, although it’s less than 0.5%, according to the paper.

With younger patients, other factors come into play. Those who undergo the operation early are more likely to achieve a high level of function than patients who wait for their knees to deteriorate. New knees can also help support a higher level of activity and the health benefits that go with it. One analysis cited by Jacobs says there’s a typical lifetime benefit of $10,000 to $30,000 due to lower absenteeism, better overall health and other factors.

On the other hand, anyone getting a knee replacement in their 50s or 60s has a good chance of experiencing a re-run: approximately 10% wear out within 15 years and need to be replaced again, says Riddle.

For more, check out the American Academy of Orthopaedic Surgeons' guide for patients.

soundoff (28 Responses)
  1. J-dog

    it's stupid to replace the knee of a person that's has been overweight and/or negligent their whole life. We get old, you won't feel like you are 20 forever. If you have the money to pay for it, more power to you. Expecting taxpayers to pay for your 25 doughnut a day habit is retarded.

    July 3, 2014 at 00:19 | Report abuse | Reply
  2. Paul

    Meniscus surgery is certainly needed in cases of Grade III tears or significant fraying of the cartilage. One must explore all options particular to the individual's lifestyle. Reference good learning resources such as the National Library of Medicine or AidMyMeniscus

    July 3, 2014 at 12:25 | Report abuse | Reply
  3. portlandtony

    "On the other hand, anyone getting a knee replacement in their 50s or 60s has a good chance of experiencing a re-run: approximately 10% wear out within 15 years and need to be replaced again, says Riddle."
    You'll probably not gonna need a knee if you get it replaced in your mid to late 60's. LOL

    July 10, 2014 at 18:39 | Report abuse | Reply
  4. fernace

    Yeah, @ J-dog, if you're 50lbs overweight knees will give out, even if you're younger! We're such a surgery happy nation, w/ all the cosmetic surgeries, I think many people view knee/hip replacements as kinda the same thing! Eating healthy, moderate exercise, losing weight are still the best ways to ensure we don't need replacement parts!!

    July 13, 2014 at 16:28 | Report abuse | Reply
    • kathycarreldridge

      There are other reasons, a former injury, scoliosis which causes your knees to wear unevenly, and other deformities . Don't judge unless you know all the facts.

      August 14, 2014 at 20:24 | Report abuse |
  5. Matt Whitehead

    I think the most important thing that is not being talked about is why do people develop osteoarthritis in the first place? It is not complicated and even the NIH in 2010 published a study on why people develop it and what makes it worse. You can read about it here: http://www.oregonexercisetherapy.com/blog/knee-joint-osteoarthritis
    The second factor to discuss is why do knee replacements fail after 10-15 years? And why do some fail much quicker than others (same manufacturer and doctor but different patients)? I talk about this subject in an article here: http://www.oregonexercisetherapy.com/blog/why-joints-fail-and-how-to-prevent-it

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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.