Knee-replacement surgery is becoming more and more commonplace. A decade ago, surgeons operated on more than 600,000 people in the U.S. alone, a number that is projected to increase six-fold by 2030. But does the procedure result in the pain-free, active life that marketers suggest? For many the answer appears to be no.
Knee Replacement Overused and Oversold
We read this provocative article on the Kaiser Health News website and we offer it to our AgingOptions blog readers as a cautionary tale. “Most knee replacements are considered successful, and the procedure is known for being safe and cost-effective,” Kaiser reports. Yet patients are not adequately warned about the procedure’s risks and limitations, says the article. As a result, “Doctors are increasingly concerned that the procedure is overused and that its benefits have been oversold.”
There’s little doubt that knee-replacement surgery is being aggressively marketed, primarily to boomers suffering knee pain as a result of arthritis, injury, or aging. “Hospitals and surgery centers market knee replacements heavily, with ads that show patients running, bicycling, even playing basketball after the procedure,” one surgeon told Kaiser Health News. Hospitals are competing with each other to convince patients into thinking that a new knee will allow them to do everything they did before, he said, but such high expectations often prove unrealistic. Medical advertising, say health care experts, is a big part of the problem because “its purpose is to sell patients on the procedures.” It appears to be a successful sell.
Knee Replacement is Big Business
According to a 2014 study cited in the Kaiser report, “One-third of patients who undergo knee replacement may not even be appropriate candidates for the procedure, because their arthritis symptoms aren’t severe enough.” So why have the operation? Clearly, the article suggests, money is a big reason why many some patients are offered surgery they don’t need. “Knee replacements, which cost $31,000 on average, are ‘really crucial to the financial health of hospitals and doctors’ practices. The doctor earns a lot more if they do the surgery,’” one surgeon acknowledged. Some quick calculations suggest that the total dollar value of knee replacement surgeries in the United States already exceeds $30 billion, and it’s rising rapidly.
Sadly, not only do many patients never experience the return to full mobility they had expected, but their knee pain remains even after replacement surgery. “Research suggests that up to one-third of those who have knees replaced continue to experience chronic pain,” says Kaiser Health News, and roughly 20 percent of patients say they are dissatisfied with the results of the surgery. (We can only assume that others are still holding out hope that their pain will eventually subside.) Kaiser quoted a study in the publication BMJ which found that knee replacement had “minimal effects on quality of life,” especially for patients with less severe arthritis. This major disconnect between expectations and outcomes seems to fuel much of the frustration many patients express when the surgery fails to deliver on its promises.
Younger Patients, Unexpected Problems
According to Kaiser Health News, improvement in medical technology has created some unexpected problems. New implants can last longer, up to 20 years, before wearing out. At the same time, knee replacement patients are getting younger, with about 40 percent between the ages of 45 and 64. As Kaiser report, “The younger patients are, the more likely they are to ‘outlive’ their knee implants and require a second surgery,” called a revision, which carries with it a host of complications and challenges from scar tissue, fragile bones, and cement from the first surgery, triggering longer recovery times and poorer outcomes. Moreover, among older patients, “even the newest [implant] models don’t last forever. Over time, implants can loosen and detach from the bone, causing pain. Plastic components of the artificial knee slowly wear out, creating debris that can cause inflammation. The wear and tear can cause the knee to break.” Obesity shortens implant lifespan even more.
The good news in all this, says Kaiser, is that knee surgery isn’t the only way to treat pain, especially when arthritis is the cause as is commonly the case. “Patients with early disease often benefit from over-the-counter pain relievers, dietary advice, physical therapy and education about their condition,” said Daniel Riddle, a physical therapy researcher and professor at Virginia Commonwealth University. Even those with more severe arthritis can experience positive outcomes from non-surgical methods. One 2018 study examined 100 older patients who were eligible for knee replacement. Some had the surgery and some received a combination of non-surgical therapies. All 100 patients showed improvement, yet “surgical patients developed four times as many complications, including infections, blood clots or knee stiffness severe enough to require another medical procedure under anesthesia.” At the end of the study, most of the “non-surgery” group, though eligible for knee replacement surgery, chose not to do it.
If you’re faced with a decision concerning knee surgery, how do you avoid the “marketing machine” and the potential dangers of an unwarranted procedure? It starts with two words: be informed. As we always do, for all matters relating to your health, we advise you to place yourself in the hands of a board-certified geriatrician, a health care professional who understands the special needs of senior adults. The right health care professional can get you on the proper course to better health and give you the best, most appropriate advice. Contact AgingOptions and let us provide you with a referral to a geriatrician near you.
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(originally reported at www.khn.org)