Knee re­place­ment re­hab ‘is just a waste of money’

The Australian - - THE NATION - SEAN PAR­NELL HEALTH ED­I­TOR

In-hos­pi­tal re­ha­bil­i­ta­tion af­ter knee re­place­ment is a waste of money, ac­cord­ing to a new study likely to put pres­sure on the pri­vate sec­tor to pur­sue cheaper op­tions for in­sured pa­tients.

Re­searchers led by as­so­ci­ate pro­fes­sor Jus­tine Nay­lor, from South Western Syd­ney Clin­i­cal School at the Univer­sity of NSW and the Ing­ham In­sti­tute of Ap­plied Med­i­cal Re­search, com­pared out­comes for to­tal knee arthro­plasty with and with­out pri­vate in­pa­tient re­ha­bil­i­ta­tion.

Their find­ings will add to con­cerns over un­nec­es­sary knee re­place­ments be­ing per­formed in Aus­tralia, which has one of the high­est surgery rates in the world.

“Re­ha­bil­i­ta­tion path­ways in­cor­po­rat­ing in­pa­tient re­ha­bil­i­ta­tion did not achieve bet­ter joint-spe­cific out­comes or health scores than al­ter­na­tives not in­clud­ing in­pa­tient re­ha­bil­i­ta­tion,” the re­searchers write in today’s Med­i­cal Jour­nal of Aus­tralia.

Not only was there a sig­nif­i­cant cost dif­fer­ence — re­ha­bil­i­ta­tion av­er­aged $9978 for in­pa­tient ser­vices com­pared to only $374 for those sent home af­ter surgery — but one health score showed a bet­ter out­come for pa­tients who did not re­main in hos­pi­tal.

“Given the sub­stan­tial dif­fer­ence in costs, bet­ter-value al­ter­na­tives than in­pa­tient re­ha­bil­i­ta­tion should be con­sid­ered for pa­tients who have not ex­pe­ri­enced a ma­jor com­pli­ca­tion or pro­gressed slowly af­ter knee arthro­plasty,” they con­clude.

“We un­der­stand pri­vate con­sumers do value in­pa­tient re­ha­bil­i­ta­tion for rea­sons other than ef­fi­cacy, but if costs of care limit the avail­abil­ity of the surgery, then costs may be bet­ter di­rected to­wards the surgery it­self.”

In an ed­i­to­rial in the jour­nal, sur­geon and past-pres­i­dent of the Aus­tralian Or­thopaedic As­so­ci­a­tion An­dreas Loe­fler sug­gests in-hos­pi­tal re­ha­bil­i­ta­tion be re­served for those most likely to ben­e­fit.

With the age­ing pop­u­la­tion and high obe­sity, the de­mand and cost of knee re­place­ments is an emerg­ing is­sue.

Be­tween 2003 and 2014, the num­ber of knee re­place­ment pro­ce­dures per­formed in Aus­tralia per an­num in­creased by 97 per cent in the pri­vate sec­tor and 71 per cent in the pub­lic sec­tor.

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