People at work are getting heavier and less active. Degenerative joint diseases, osteoarthritis (OA) sets in and worsens their mobility, resulting in even more weight gain. A true vicious cycle.  In patients with end-stage knee OA, total knee replacement (TKR) is an effective treatment after all else has been tried and failed.

Employer sponsored health plans pick up the tab for many of the almost million total knee replacements (TKR) done in the US, with an average cost of $31,000 in 2018. Within a PPO network, we notice a big claim paid amount difference for the same TKR surgery. It can range from $30,000 to almost $70,000.

Hospitals and orthopedic ambulatory surgical centers invest heavily in marketing the promise of a TKR on billboards, TV ads, social media storytelling. and patient video testimonials. It is a profitable service line for the not-for-profit health systems. They invest big money raised on Wall Street with their valued bond ratings into its high tech operating rooms, 5T magnet MRIs, luxurious recovery suites, shiny glass and steel hospital within a hospital dedicated to joint and spine surgeries.

We have to ask why the rates of the TKR surgery doubled from 1999 to 2008?

It is frightening that almost 3.5 million TKR surgeries a year are expected by 2030.

If you are the plan sponsor, CEO, CFO, CHRO of an employer-sponsored, self-funded health plan, you need to have a health communication strategy of your own to help your employees and their dependents on your health plan make the best informed healthcare decisions in partnership with their doctors.

The timely article by Liz Szabo of Kaiser Health News confirms that at Pequot Health Care we are on the right track of setting up employee health communication and concierge service focused on Arthritis Care Excellence (ACE) program.

• One-third of those who have knees replaced continue to experience chronic pain, while 1 in 5 are dissatisfied with the results.
• A study published in 2017 in the BMJ found that knee replacement had “minimal effects on quality of life”
• Another research paper suggest that one-third of patients who undergo knee replacement may not even be appropriate candidates for the procedure
• Patients with arthritis of knee will often benefit from over-the-counter pain relievers, dietary advice, physical therapy and education about their condition
• 1 in every 100 to 200 patients who undergo a knee replacement die within 90 days of surgery.
• Researchers compared surgical and non-surgical treatments in 100 older patients eligible for knee replacement.
• Significantly, most of those treated with non-surgical therapies were satisfied with their progress. Although all were eligible to have knee replacement later, two-thirds chose not to do it.

As the great review in the journal Lancet says:

The pioneering days of knee-replacement surgery have probably ended, and future emphasis should first be on improvement of patient selection for surgery and reductions in variability in provision of surgery through education, training, and the use of well designed decision aids.