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AAOS: High Prevalence of Low-Value Interventions in Pre-Op Knee OA

The American Academy of Orthopaedic Surgeons announced five measures that inappropriately increase costs in those undergoing total knee replacement (TKR).  Data was presented yesterday at the annual 2017 AAOS Annual Meeting in San Diego.

They stated that in the year prior to TKR, almost one-third of the costs for treatment of arthritis symptoms went toward strategies not recommended by the AAOS,

Review of claims data from Humana (both private and Medicare Advantage plans) from more than 86,000 patients with osteoarthritis of the knee and undergoing TKR within one year were reviewed looking for the use of hyaluronic acid (HA) or corticosteroid (CS) injections, physical therapy (PT), braces and wedge insoles, pain medication, and NSAIDs.

Of these only three were recommended by the AAOS clinical practice guideline ("Non-arthroplasty Treatment of Osteoarthritis of the Knee.") — specifically physical therapy, NSAIDs, and the tramadol. 

The total costs associated with outpatient knee osteoarthritis was $43,582,648 and that this could be decreased by as much as 30% by avoiding the following. 65.8 percent of the patients (56,960) underwent at least one of the analyzed treatments in the year prior to their TKR.

  • Not recommended: included 2 of the 3 most costly treatments - HA injections, CS injections and PT. These accounted for 52.6 percent of expenses (excluding hospital or inpatient), total costs of knee osteoarthritis in the year prior to TKR.
  • Recommened interventions (PT, NSAIDs and Tramado) accounted for 11 percent of the total costs. 
  • 65.8 percent of the patients underwent at least one of the treatments listed above in the year prior to their total knee replacement.

Their research shows there is a high prevalence of these low-value interventions in the management of knee osteoarthritis in the time these patients are transitioning to joint arthroplasty.

The author has no conflicts of interest to disclose related to this subject

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