WASHINGTON (AP) - Knee replacement surgery is a safe and cost-effective treatment for persistent knee pain and disability, and increasing numbers of patients are seeking it at an earlier age, a panel of experts told the National Institutes of Health on Wednesday.
The panel found that the procedure, in which the moving parts of the knee are replaced with a man-made joint, is performed in about 300,000 patients a year in the United States. That number is expected to grow as the American population ages, the panel said in a report to NIH.
Dr. E. Anthony Rankin of Providence Hospital in Washington said the procedure is not for everyone. "It's major elective surgery that carries a variety of important risks, but it often offers dramatic relief after other therapies fail," he said.
The panel of experts said studies show the failure rate is about 1 percent per year over a 20-year period.
By far, the majority of patients who receive the operation are elderly Medicare beneficiaries, but the age of patients has declined in recent years, the panel said. Today, it's not uncommon for 50-year-olds to get new mechanical knees.
The average cost of a total knee replacement, experts said, is about $32,000, including the cost of the hospital, the surgeon and the device itself.
The panel found the same racial and ethnic disparities for knee replacement that are seen in other fields of medicine and called for a study to determine why fewer minorities are getting the surgery.
From 1998-2002, the surgery was performed at the annual rate of 4.8 per 1,000 white males, 3.5 per 1,000 for Hispanic males and 1.9 per 1,000 for black males, according to Medicare data cited by the report.
The disparity could be due a number of causes, the panel said, including physicians' beliefs about their patients, limited familiarity with knee replacement in minority communities and patient mistrust of the health care system.
The panel, comprised of experts in the field, spent three days reviewing the latest medical findings on total knee replacement. Its report will influence the way doctors treat patients in the United States.
For those who get the procedure, the panel found that it is successful in the vast majority of patients.
The most common cause of failure is a loosening of the implant caused by a biological reaction to the metal and plastic parts of the device.
Another problem is misalignment but new techniques are being developed to reduce this risk, the panel said.
The panel said that the procedures tend to be more successful if the patients work with their primary physician and the orthopedic surgeon in preparation. The experts said preparation would include losing weight for obese people and strengthening the muscles.
"There needs to be a coordinated effort between the patient and his doctors to get a better result," said Sue Karen Donaldson, a professor of physiology at Johns Hopkins University in Baltimore and a member of the advisory panel.
