Research reveals orthopaedic surgery has a social and economic impact
Total knee replacement (or total knee arthroplasty (TKA)) is one of the most successful and life-enhancing surgical procedures. It relieves almost all pain for 90 percent of patients who have the procedure, allowing them to return to work and tremendously enhancing their quality of life.
A new study published in 2013 by the Journal of Bone and Joint Surgery (JBJS) and conducted by health economists has confirmed total knee replacement surgery to be a cost-effective treatment for patients with end-stage osteoarthritis. By modeling indirect savings of the individual returning to the workforce after surgery, researchers found a lifetime societal net benefit for patients undergoing knee replacement averages between $10,000 – $30,000.
More than 600,000 knee replacements are performed each year in the United States. With an aging population staying in the workforce longer and obesity on the rise, demand for total knee replacement surgery is expected to exceed 3 million by the year 2030.
Given the increased focus on the cost effectiveness of health care, this study compared direct and indirect costs between surgical and non-surgical treatments. The increased direct costs for a knee replacement (e.g., all medical costs for surgery and rehabilitation) averaged $20,635, but these expenses are offset by indirect savings equal to $39,565.
Of the $10,000 – $30,000 in lifetime societal net savings, 85 percent of indirect savings originated from increased income, through a combination of increased probability of working and higher earnings. The remaining 15 percent of societal savings came from indirect costs such as fewer missed work days and lower disability payments.
The study estimates lifetime societal savings (net present value) of about $12 billion from the more than 600,000 total knee replacement surgeries performed each year in the U.S. These societal savings primarily accrue to patients and employers.
In addition to the video at the top of the page, more information is available here:
- AAOS News Release on the Societal Impact of Knee Replacement
- Audio News Release on Health Economics Study
- Video of knee replacement patient Linda Seward talking about her procedure
- Video of William J. Robb III, MD discussing the value of total knee replacement
- Video of AAOS Past President John R. Tongue, MD on Health Economics Study
Frequently Asked Questions
- What is the most common cause of chronic knee pain?
The most common cause of chronic knee pain and disability is arthritis. Although there are many types of arthritis, most knee pain is caused by osteoarthritis, rheumatoid arthritis, or post-traumatic arthritis.
- What is a knee replacement and why is it performed?
A doctor may recommend knee replacement surgery if a person is experiencing severe knee pain or stiffness that occurs during rest or limits everyday activities, chronic knee inflammation and swelling that does not improve with physical therapy, rest or medications, or a knee deformity — a bowing in or out of the knee.
- How was the study conducted?
Using a research tool called a Markov model, researchers estimated the value of total knee replacement for patients by comparing direct and indirect costs between surgical and non-surgical treatments. Costs and quality of life measures were incorporated into the Markov model to estimate the impact of surgery on a patient’s lifetime costs and quality-adjusted years. Model assumptions were developed using claims and survey data as well as clinical expert opinion and peer-reviewed literature.
- What did the study conclude?
The study showed that for patients who received total knee replacement surgery, lifetime societal net benefit per patient averages between $10,000 – $30,000. Compared with non-surgical treatment, knee replacement surgery increases direct costs by $20,704, but the societal savings that result from reduced indirect costs as a result of improved function are equal to $39,697.
- How will the research be used in the future and what is its impact on health care costs?
This is the first study to demonstrate the importance of a societal and economic impact related to knee replacement surgery. It provides valuable perspective when considering the costs and benefits of total knee replacement and policies that will affect access to this procedure.