Study Finds Sizeable Underutilization Of Hip And Knee Replacement Procedures

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Study Finds Sizeable Underutilization Of Hip And Knee Replacement

Procedures

http://www.medicalnewstoday.com/medicalnews.php?newsid=44465

A Duke University study reports that of those men and women whose

physicians recommended a total hip or knee replacement, a staggering

92 and 88 percent, respectively, did not take advantage of these

surgical procedures, despite their safety, success rates and long-

term positive outcomes. Fear of pain or worsened mobility,

misperception of advances in the rehabilitation process, and lack of

awareness of the full range of benefits afforded by such

interventions is behind the high patient refusal rates, the study's

investigators surmised.

The report by the Duke University Medical Technology Assessment

Working Group is based on a survey of literature published since 1993

and findings from National Institutes of Health consensus panels held

in 1993 and 2001. The Duke team studied medical device interventions

for the treatment of osteoarthritis and osteoporosis-related

fractures.

Despite gaps in the volume of existing literature, the researchers

found total hip and knee replacement surgery to be safe, with low

post-operative complications and mortality rates. In addition,

implant survival rates were well above 90 percent after 10 years;

patient satisfaction levels stood firm at 85-90 percent; and the

procedures themselves were highly effective in relieving pain and

restoring function. The study's sources did not include people who

might benefit but had not visited a doctor, those who did not reveal

all pain issues to their physicians, or who were not appropriate for

replacement surgeries because of other medical conditions.

" Clinical results for knee and hip replacements are among the best of

any procedure we've examined and the long-term benefits and

improvements to quality of life are profound, " said ,

Ph.D., professor and project director of the study. " This phase of

our study has clearly indicated a dire need for an increase in public

education related to medical devices and diagnostics, even via

advertising, so that people better understand the benefits - and be

less fearful about the process. This would lead to increased

acceptance of these kinds of surgical procedures. "

Researchers also found substantial disparities in utilization across

race and gender lines, but were unable to pinpoint the root causes.

For example, African Americans and Hispanics have no less need for

hip or knee replacements than whites, but they choose them less

often.

Further, women are more likely than men to have osteoarthritis of the

hip, but do not undergo replacements until an advanced state of

disability, which results in a longer rehabilitation and poorer

outcome.

According to , the Duke team was surprised to find how little

had been done to study outcomes and the timeframes in which patients

were monitored. Range of motion and pain reduction were checked in

the hospital or a rehabilitation facility in the days or weeks

immediately after a surgery, but not beyond.

" When you're talking about an older population, you're not looking

for a return to work, necessarily, but people who can now - or

continue to - take care of themselves and do their own shopping or

housework may not need assisted living or nursing home services, "

said . " Most data are limited to studies in one or two medical

centers and does not reflect the kind of monitoring that is the norm

in the average community hospital. We will be analyzing data from

thousands of people from all across the country to make better

estimates of levels of disability - and impacts on quality of life -

resulting from joint replacements. "

Team to study long-term effects on " human capital "

The on-going Duke study will use data drawn from the Center for

Medicare and Medicaid Services and the National Long Term Care Survey

to explore the effects of medical technology innovations such as knee

and hip replacements on human capital - the economic savings in terms

of productive activities.

The Duke University study is funded by a grant from InHealth: The

Institute for Health Technology Studies, a nonprofit research and

education organization whose mission is to examine the role, impact

and value of medical technology, thereby enhancing a climate of

health care innovation for public benefit.

" Clearly, there is a need for more evidence-based research on the

impact of knee and hip replacements on the health and quality of life

of patients, " said Martyn Howgill, executive director of

InHealth. " We fund grants like this to provide information and

insights to patients, caregivers and health policy makers so that

they can make informed decisions. "