Soaring knee surgeries put strain on budgets

The number of total knee replacement surgeries has soared 161.5% among Medicare participants in the past 20 years, a $5 billion annual tab that will continue to grow as the USA’s 77 million Baby Boomers age, a large study reported Tuesday.

The wider use of knee replacement is good news for the rapidly aging population. But while it eases pain and improves quality of life, it “can be viewed as another strain on govern-

ment, individuals and businesses struggling with unremitting growth in health care costs,” the authors say in the Journal of the American Medical Association.

“People are living longer and want to be active,” says lead author Peter Cram, a physician at the University of Iowa Carver College of Medicine in Iowa City. “They feel great after this.” The challenges, he says, are how to address post-surgery problems and how to ensure that doctors are not overusing a “highly reimbursed procedure.”

A knee replacement costs Medicare about $15,000, a number that would be higher, the authors say, had Medicare not taken cost-lowering measures of shortening hospital stays and encouraging outpatient rehab. Those strategies, however, can lead to problems for some patients and add costs and longer recovery times.

The study is the first to look at trends and outcomes linked to total knee replacement, the authors say, and includes a breakdown of factors that can lead to rehospitalization and additional surgeries.

From 1991 to 2010, 3.27 million patients 65 and older had total knee replacements, and 318,563 had revi- sions to fix problems. The number of primary knee replacements among Medicare patients increased from 93,230 in 1991 to 243,802 in 2010; revisions increased from 9,650 to 19,871.

In an editorial, the authors say demand for knee replacements could be as high as 3.48 million a year by 2030.

Though healthier patients would use less health care, surgeries also “will be a driver of health care costs,” the authors say. Doctors must address “predisposing modifiable factors such as obesity” and develop better treatments for mild arthritis to prevent progression requiring surgery.