TKR Lowers Mortality Risk and Heart Failure in the Elderly

SAN FRANCISCO—New research presented at the 2012 Annual Meeting of the American Academy of Orthopaedic Surgeons highlights the benefits of total knee replacement (TKR) in elderly patients with osteoarthritis, including a lower probability of heart failure and mortality.
Investigators reviewed Medicare records to identify osteoarthritis patients, separating them into two groups—those who underwent TKR to relieve symptoms, and those who did not. Outcomes of interest included average annual Medicare payments for related care, mortality, and new diagnoses of congestive heart failure, diabetes and depression. Differences in costs and risk ratios were adjusted for multiple variables including age, sex, race and region. The results (adjusted for underlying health conditions) were compared at fixed periods of one year, three years, five years and seven years after surgery.

The seven-year cumulative average Medicare payments for all treatments were $63,940 for the non-TKR group and $83,783 for the TKR group, for an incremental increased seven-year cost of $19,843. The cost does not include prescription drugs, which are reportedly much higher in the non-TKR group.

There were significant positives in the osteoarthritis TKR group: the risk of mortality was half that of the non-TKR group and the congestive heart failure rate also was lower, at three, five, and seven years after surgery. There was no difference in diabetes rates among both groups. Depression rates were slightly higher in the TKR group during the first three years after surgery, though there was no difference at 5 and 7 years.

"These patients had improved survivorship and reduced risk for cardiovascular conditions," said Scott Lovald, PhD, MBA, lead investigator and senior associate at Exponent, Inc. "More specifically, total knee replacement in osteoarthritis patients may reduce patient mortality by half. There are few health care investments that are so cost effective.

—Brought to you by the AAOS