Western medicine is widely accepted throughout the industrialized world, but countries have different standards with which treatments are evaluated. By processing patient data of American patients within the efficacy models established in other countries, it’s possible to better understand how US medical expectations compare to those outside our borders. A June 2014 study cross-culturally examined the most intensive form of knee surgery performed on patients in the United States.

The study – published in Arthritis & Rheumatology – reported that one out of every three US knee replacements is not medically appropriate when assessed with classification systems used in Spain and Canada. The statistics from the Agency for Healthcare Research and Quality increase the plausibility that replacement is overused as a treatment for knee pain. Over half a million (600,000) replacement operations take place in American hospitals and surgical centers each year. The procedure has become commonplace specifically during the last two decades, with the number of surgeries increasing 162% between 1991 and 2010.

Study is the first of its kind

The knee replacement study was the first scientific effort to apply criteria related to medical appropriateness directly to real replacement records. The researchers used two medical categorization frameworks: one from Spain to gauge medical appropriateness, and one from Canada to measure knee pain and functionality (the Western Ontario and McMaster Universities Arthritis Index, a.k.a. WOMAC).

The Spanish criteria are respected by leading knee pain relief professionals. Chief author Daniel L. Riddle, a professor at Virginia Commonwealth University, called the Spanish scale “among the most powerful tools” available to achieve more consistent healthcare outcomes and to reduce treatment costs.

The study reviewed the records of over 4000 patients between 2009 and 2014, locating surgery cases with the data needed for proper analysis via the Spanish system. Of those thousands of patients, 175 were directly assessed for appropriateness. All of the patients were members of the Osteoarthritis Initiative, a five-year program financed in part by the National Institutes of Health (NIH). Using WOMAC to better systematize the data and the Spanish model to determine appropriateness, the findings are unsettling to many knee pain relief practitioners and patients:

  • 44% of knee replacements are medically necessary
  • 34% are medically unnecessary
  • 22% of cases are undetermined.

Safe solutions for knee pain

Many doctors and other providers who specialize in pain management are concerned by the recent spike in knee replacement surgeries. As is suggested by this study, surgery is not only expensive but could also be recommended inappropriately. Our entire focus at Health Star Clinic is on non-surgical solutions. Get help now with a free consultation.