Marked variability seen in total knee arthroplasty indications

(HealthDay)—There is considerable variability associated with total knee arthroplasty (TKA) recommendations, according to a report published in the May issue of Pain Medicine News.

Liana Fraenkel, M.D., M.P.H., from the Yale School of Medicine in New Haven, Conn., and colleagues surveyed 406 orthopedic surgeons and 494 rheumatologists to examine whether they recommended TKA in various scenarios involving a 62-year-old patient with knee osteoarthritis and moderate pain.

The researchers found that for a patient described as having mild radiographic osteoarthritis and moderate pain, the proportion of physicians who recommended TKA ranged from 30 to 55 percent. For a patient with moderate radiographic osteoarthritis and moderate pain, the proportion recommending TKA ranged from 39 to 71 percent. The proportion who recommended TKA varied significantly according to gender (59 percent for a male patient compared with 44 percent for a female patient). Compared with European surgeons (34 percent), U.S. surgeons were more likely to recommend TKA (52 percent). Rheumatologists and surgeons aged 40 years or younger were significantly more likely to recommend TKA (61 versus 46 percent for rheumatologists; 60 versus 48 percent for surgeons). Rheumatologists who were academics were significantly more likely to recommend TKA (63 versus 48 percent). Rheumatologists were also significantly more likely to recommend TKA for patients with moderate versus mild X-ray changes (60 versus 41 percent), and to retirees versus working people (56 versus 42 percent).

"Studies are needed to determine appropriateness criteria for TKA in order to reduce the unwarranted variability associated with TKA," Fraenkel said in a statement.