New Knee Increases Mobility in Older Patients
Cited: MedPage Today
Duke University has conducted a new study that helped researchers discovered that a total knee arthroplasty (TKA) received by older patients with art osteoarthritis in the knee have resulted in significant improvement of mobility and physical functioning, long-term, compared to patients who did not receive a TKA.
Published in the July 2009 issue of Medical Care, the study examined physical functioning and gauged outcomes in a national sample of Americans aged 65 and older for up to four years-a longer period than previous TKA studies. Relative to the untreated comparison group, recipients of total knee replacements experienced significant improvement in function, including a 17.5% increase in mobility, a 39.3% improvement in motor skills; and a 46.9% decrease in limitations in activities of daily living such as bathing and dressing oneself.
The number of total knee replacements performed in the United States has increased dramatically since 1990; currently 581,000 such procedures are performed every year. This number is expected to increase markedly as Baby Boomers age.
“In this era of cost-cutting, policymakers have underscored the importance of evaluating treatments in terms of effectiveness and benefits to patients,” says lead author Frank Sloan, Ph.D., McMahon professor of health policy and management and professor of economics at Duke University. “Our findings show that knee replacements are effective in treating patients with advanced osteoarthritis, contributing to reduced disability and improved quality of life for these individuals. Such findings are extremely important for the broader context of discussions about healthcare reform, cost-containment, device quality, and patient safety.”
For the study, Duke researchers identified 2272 patients diagnosed with osteoarthritis of the lower leg using data from the Health and Retirement Study (HRS) linked to Medicare claims from 1994 through 2006. Of that group, 516 underwent TKA procedures and 1756 did not. Researchers used propensity score matching to generate 515 pairs of treated and untreated individuals who were matched on relevant, measurable factors such as baseline functional status, other health conditions, socioeconomic characteristics, and time before TKA or diagnosis.
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Among the patients who underwent TKA, baseline physical functioning measures were taken at an interview before and closest to surgery. For the comparison group, these measures were taken from an interview preceding and closest in time to the year of their first diagnosis with osteoarthritis of the lower leg. Each pair was followed for up to four years, and their resulting physical abilities were compared.
The study’s mobility, gross motor skills, large muscle activities, and limitations in activities of daily living indices accounted for a wide breadth of physical activities, including getting in and out of bed; the ability to bathe and dress oneself; sitting for two hours; getting up from a chair; stooping, kneeling, and crouching; walking across the room, one block, and several blocks; climbing one flight and several flights of stairs; and pushing and pulling a large object.
The study comes at a time when Congress and the nation’s healthcare agencies are looking for ways to identify diagnostics and therapies that offer the greatest value to patients and the healthcare system. Representatives Bill Pascrell Jr. (D-NJ) and Lloyd Doggett (D-TX) have introduced legislation to establish a federally-funded registry of patients who have received artificial hips or knees, providing researchers and policymakers with an ongoing source of data about patient outcomes with such devices and related surgical procedures.
According to Sloan, total knee replacement has repeatedly been shown to offer clinical benefits for patients with osteoarthritis, a major risk
factor for disability in the United States. Recently, a team at Brigham and Women’s Hospital and the Boston University School of Public Health confirmed that, for older adults with advanced osteoarthritis, total knee replacement also appears to be a cost-effective procedure across all patient risk groups.
“We know that the inability to perform activities of daily living is highly predictive of nursing home admittance, as patients can no longer care for themselves,” says Sloan. “TKA offers the potential for extending independence and therefore delays the need for assisted living.”
The study was written up by David Ruiz Jr., MA, and Alyssa Platt, MA at the Duke University and supported by a grant from the Institute for Health Technology Studies (InHealth).
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My Take: I know something about this one subject. I have not had the surgery myself, and hopefully I will not need it, however my mother has had the surgery twice. My mother has been disabled since she was two years old. An accident killed the growing nerve in one of her legs and she has had several surgeries on that leg for most of her youth and teenage years.
At the age of 15, she was told that she would never walk without the brace on her leg. That was in 1934. When she got home, she took that brace off and threw it into the garbage can five minutes before they picked up the garbage. The only time she ever wore brace after that was when she had her knee replaced. She was also told she would never be able to work standing on her feet. Needless to say, most of the jobs my mother is held throughout her life were jobs that she had to do on her feet. Can you guess that my mother is a very stubborn woman?
Eventually, the normal wear and tear on her leg began to get to her and she aged. When she finally set aside her stubbornness and went to a doctor, her knee joint had about a quarter of an inch left. The doctor was very curious as to how she was walking with so little over joint left. That was 30 years ago and she has had a second TKA since then as well as a hip replacement.
However, that first TKA brought about a miracle to my mother. When she awoke from the anesthetic, she said that something was wrong, but she was unable to figure out what was. The doctors began to worry that there was a complication. When they began to examine her leg for possible problems she exclaimed, “I know what’s wrong!” It was the simple fact that she was no longer in any pain. Needless to say, the doctors were very relieved that there were no problems with the knee. She had to have the knee replaced about 20 years later, even though they told her that first one would only last about a year or two. Of course, technology has improved enough to where she has not had to have it replaced again.
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