Study attributes excess in TKR management costs to excess of investigation

Better management and treatment protocols are needed to reduce the amount spent on excessive investigation of total knee replacements, according to a recently presented study.

The findings were presented by Al-Amin Kassam at the British Orthopaedic Association and the Irish Orthopaedic Association Combined Meeting 2011, in Dublin.

“We wanted to work out how much is spent on investigating these painful knee replacements,” Kassam said. “We found a lot of people have primary total knee replacements under non-specialty surgeons, and when they came back with a painful knee they were referred to a specialty surgeon. We felt this was doubling the costs.”

Kassam and his team looked at 42 cases of patients reporting a painful total knee replacement (TKR). Appointment costs were calculated, along with serological and radiological investigation costs. The average cost of investigating each individual patient was then ascertained, Kassam said. Various operative and nonoperative management costs were also calculated and correlated with patient outcomes.

According to the study results, 41 patients were reported to have an average investigation time of 20 months with four orthopedic appointments. The investigations included, on average, eight blood tests and eight radiographs. This amounted to an average cost-per-patient of £2,337.

Twenty-two of the patients underwent operative treatment, while the 19 others received pharmaceutical treatment. Amounts spent on each group varied significantly, Kassam reported, with £5,051 being spent per patient in the operative group and £190 being spent per patient in the nonoperative group. Percentage of patient improvement was found to be superior in the nonoperative group, he added.

Kassam said the high costs associated with investigating a painful TKR are related to high numbers of repeated investigations. He attributed some of this trend to a lack of current guidance on the management of painful TKR, adding that careful thought should be used in the investigation and management of these cases.

“We have changed our practice, and now we have early referral to a specialist … we routinely advocate early pharmacological physiotherapies before rushing any form of surgery, and this has decreased our costs across the department,” Kassam concluded. “We find less appointments, less unnecessary investigations and less cost.”

Reference:

Kassam A-A, Dieppe P, Toms A. An analysis of time and money spent on investigating painful total knee replacements. Presented at the British Orthopaedic Association and the Irish Orthopaedic Association Combined Meeting 2011. Sept. 13-16. Dublin.

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