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| |  Total Knee Replacement on the Rise Among Younger Individuals: Presented at AAOS By Sophie Bainbridge NEW ORLEANS -- March 17, 2010 -- More individuals aged younger than 65 years are having total knee replacement than ever before, according to research presented here at the 2010 Annual Meeting of the American Academy of Orthopedic Surgeons (AAOS). Possibly as a result of this, Medicare is paying less for these procedures, said lead investigator Michele R. D’Apuzzo, MD, Mayo Clinic, Rochester, Minnesota, during a presentation here on March 12. “There are about 270,000 primary total knee replacement operations performed each year in the United States and that number is expected to increase to as much as 450,000 by the year 2030,” Dr. D’Apuzzo noted. “Despite this increase we have had very little data on patient characteristics and demographic trends, the type of institutions caring for these patients, length of hospital stay, and payer information, and we wanted to document this information in a rigourous study.” He and his colleagues compared nationally representative data from the Centers for Disease Control and Prevention’s National Hospital Discharge Surveys for 1990-1994 and 2002-2006 for patients having total knee replacements. About 800,000 procedures were performed in 1990-1994 and 2.1 million in 2002-2006. The study found that the average age of total knee replacement patients decreased by 2 years (from 70 years to 68 years; P < .001)) between the 2 time periods, and that the percentage of minorities having the procedure increased by 1.4%, going from 8% to 9.4% (P < .001). The study also found that Medicare is paying less for total knee replacements and that the length of hospital stays decreased. The Medicare payment for the procedures dropped from 72.1% to 61.4% (P < .001). Mean length of hospital stay went from 8.4 to 3.9 days (P < .001), and a higher percentage of patients were discharged from hospital to short or long-term facilities in the most recent period (21.2% vs 40.8%; P < .001). Hospitals with less than 300 beds were more common in the most recent group (63.1% vs 72.2%; P < .001). “We are doing surgery in younger patients overall,” said Dr. D’Apuzzo. “We are doing fewer total knee replacements in patients older than 65 years, and are doing more in patients younger than 65 years. This is one reason why Medicare is paying less. We don’t know the other reasons, but we speculate that more patients are opting to have total knee replacement in non-Medicare centres.” Total knee replacement techniques and materials have improved considerably since 1990, and surgeons have more confidence in performing the operation in younger patients, he added. “Years ago, we used to delay surgery as much as we could, but we have better materials now and the prosthesis lasts longer, so if we can provide a better quality of life with a knee arthroplasty, we will do so,” Dr. D’Apuzzo said. The information from this study will be useful in planning for the future, he said. “Total knee replacements aren’t going away any time soon. We’re going to be seeing younger patients, but we may also see more failures and more revisions. Physicians and medical facilities need to prepare for that.”
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