Friday, June 26, 2009

Untold story - Knee Replacment - Another Untold Story

One of the untold stories about modern medical technologies is that they often restore people to normal function. I have coffee morning with 12 men over 65. All are physically and socially active, and more than half have had some medical procedure – a knee or hip replacement, open heart surgery, a cardiac stent, cataract surgery, CT or MRI scans to reveal the nature of their condition, invasive urological or abdominal procedures – to make them whole again.

One of the untold stories of health reform is that aging citizens have great expectations of the health system and its ability to help them live a graceful and fulfilling old age. There is much talk about “over-treatment” “unnecessary procedures,” and “too much money spent on the last illness,” and the necessity to spend billions of comparative effectiveness research, but precious little is said about restoration to a normal functioning life style

I have many friends who have had knee replacements – and all agree their new knee erases pain and makes them more functional. Indeed, most result normal lifestyles before their arthritic knee or knees crippled them. Well, a study has just come in analysis has just come in from the Archives of Internal Medicine indicating that knee replacement, which has an average cost of $20,000, are cost effective in restoring quality of life.

Here is the story, as told by a Wall Street Journal reporter in the June 23, 2009, edition of that newspaper ,“Knee Replacements Are Determined to Be Cost-Effective.”
A $20,000 procedure to replace a knee ravaged by arthritis in the elderly is generally a good deal for both patients and the federal Medicare program that pays the bill, according to a new study.

In the study, based on a computer model using Medicare claims and other data, total knee replacement provided about one year of better quality of life compared to that experienced by patients who didn't have the procedure, researchers said. The average age of patients whose data were included in the model was 74.

Here is the key paragraph in the report,

Almost 500,000 knee replacements cost the U.S. more than $11 billion in 2005, and the number of surgeries is growing rapidly due to increased life expectancy and rates of obesity, the researchers said. Other studies indicate total knee replacement is 90% effective in relieving pain and improving function.

I predict similar results will be found for hip replacements, cataract surgery, and cardiac stents( in patients with acute symptoms but not with stable angina. Since these procedures account for much of Medicare spending, I would hope the proposed Comparative Effectiveness Institute start with these procedures. I hope also concurrent polls are conducting among older Americans about their expectations of having access to these restorative procedures.

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