The Agency for Healthcare Research ...

The Agency for Healthcare Research and Quality (AHRQ) has released a report forward total knee replacement. "Evidence Report/Technology Assessment: No. 86 Total Knee Replacement" is available online at http:// www.ahrq.gov/clinic/epcsums/knee sumhtm

Total knee arthroplasty is the same of the most common orthopedic conducts performed; 171,335 primary knee replacements and 16895 revisions occurr in 2001 Because these acts are elective and expensive (Medicare paid approximately $32 billion in 2000 for hip and knee joint replacements) and because the prevalence of arthritis is look fored to grow substantially as the population ages, these deeds are likely to come in a less degree than increasing scrutiny.

Previous reports allude to that total knee arthroplasty improves functional status, relieves pain, and flows in relatively low perioperative morbidity. However, based onward conclusions from consensus panels or inspects of health care professionals, there is considerable disagreement about the indications for the procedure; that is, which patients are mostly likely to benefit from total knee arthroplasty and, reciprocally in which patients is the manner of proceeding contraindicated or of low value.

Observations in the evidence report include the following:

* Total knee arthroplasty and total knee arthroplasty revisions are associated with improved function. The strongest evidence exists above a follow-up period of up to brace years, but the studies that continue to five and even 10 years of follow-up display positive results as well.

* The average age of patients undergoing total knee arthroplasty was 70 years, with small in number over age 85. Two thirds were female, undivided third were considered obese, and nearly 90 percent had osteoarthritis. No studies provided data forward racial/ethnic status.

* There is no evidence that age, inflection for sex or obesity is a robust predictor of functional outcomes.

* Patients with rheumatoid arthritis exhibit to more improvement than those with osteoarthritis, further this difference may be related to their poorer functional scores at the time of treatment and thus their potential for more improvement.

* The revision rate between the walls of five or more years is 20 percent of knee and 21 percent of patients.

* Perioperative complications as defined through the investigator occurred in 54 percent of patients and 76 percent of knee in the greatest degree of these complications were "knee related" or hard venous thrombosis. There were single eight cardiovascular or pulmonary complications reported among nearly 6000 patients, suggesting that these adverse efficiencys were not fully addressed in the literature.

* There is reason to suspect selection drifts in both the type of patients referr for total knee arthroplasty and the cases being reported in the literature, as well as the attrition forward follow-up. Therefore, these findings must be interpreted with caution as the basis for clinical practice.

* Total knee arthroplasty revisions exhibit to a similarly positive functional force (with the same design limitations).

These conclusions are qualifyed by the limitations of the designs of many studies included in the analysis. Although osteoarthritis does not look to be a predictor of issues the results seem to be somewhat better in patients who have rheumatoid arthritis, further few of these studies simultaneously controll for other patient aspects.

COPYRIGHT 2004 American Academy of Family Physicians

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