Study finds sizeable underutilization of hip and knee replacement procedures

WASHINGTON, June 2, 2006 A Duke University study reports that of those men and women whose physicians recommended a total hip or knee replacement, a staggering 92 and 88 percent, respectively, did not take advantage of these surgical procedures, despite their safety, success rates and long-term positive outcomes. Fear of pain or worsened mobility, misperception of advances in the rehabilitation process, and lack of awareness of the full range of benefits afforded by such interventions is behind the high patient refusal rates, the study's investigators surmised.

The report by the Duke University Medical Technology Assessment Working Group is based on a survey of literature published since 1993 and findings from National Institutes of Health consensus panels held in 1993 and 2001. The Duke team studied medical device interventions for the treatment of osteoarthritis and osteoporosis-related fractures.

Despite gaps in the volume of existing literature, the researchers found total hip and knee replacement surgery to be safe, with low post-operative complications and mortality rates. In addition, implant survival rates were well above 90 percent after 10 years; patient satisfaction levels stood firm at 85-90 percent; and the procedures themselves were highly effective in relieving pain and restoring function. The study's sources did not include people who might benefit but had not visited a doctor, those who did not reveal all pain issues to their physicians, or who were not appropriate for replacement surgeries because of other medical conditions.

"Clinical results for knee and hip replacements are among the best of any procedure we've examined and the long-term benefits and improvements to quality of life are profound," said Linda George, Ph.D., professor and project director of the study. "This phase of our study has clearly indicated a dire need for an increase in public education related to medical devices and diagnostics, even via ad

Contact: Michael Stewart
InHealth: The Institute for Health Technology Studies

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