title: The AAHKS Clinical Research Award: What Are the Costs of Knee Osteoarthritis in the Year Prior to Total Knee Arthroplasty?
abstract: Despite American Academy of Orthopaedic Surgeons Clinical Practice Guidelines (CPGs) related to the non-arthroplasty management of osteoarthritis (OA) of the knee, non-recommended treatments remain in common use. We sought to determine the costs associated with non-arthroplasty management of knee OA in the year prior to total knee arthroplasty (TKA) and stratify them by CPG recommendation status.
  
  
  
  The Humana database was reviewed from 2007 to 2015 for primary TKA patients. Costs for hyaluronic acid (HA) and corticosteroid injections, physical therapy, braces, wedge insoles, opioids, non-steroidal anti-inflammatories, and tramadol in the year prior to TKA were calculated. Cost was defined as reimbursement paid by the insurance provider. Costs were analyzed relative to the overall non-inpatient costs for knee OA and categorized based on CPG recommendations.
  
  
  
  In total 86,081 primary TKA patients were analyzed and 65.8% had at least one treatment in the year prior to TKA. Treatments analyzed made up 57.6% of the total non-inpatient cost of knee OA in the year prior to TKA. Only 3 of the 8 treatments studied have a strong recommendation for their use (physical therapy, non-steroidal anti-inflammatories, tramadol) and costs for these interventions represented 12.2% of non-inpatient knee OA cost. In contrast, 29.3% of the costs are due to HA injections alone, which are not supported by CPGs.
  
  
  
  In the year prior to TKA, over half of the non-inpatient costs associated with knee OA are from injections, therapy, prosthetics, and prescriptions. Approximately 30% of this is due to HA injections alone. If only interventions recommend by the CPG are utilized then costs associated with knee OA could be decreased by 45%.
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Bedard
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
authors.forename: Spencer B
authors.initials: SB
authors.lastname: Dowdle
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Anthony
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
authors.forename: David E
authors.initials: DE
authors.lastname: DeMik
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
authors.forename: Michael A
authors.initials: MA
authors.lastname: McHugh
authors.affiliation: Department of Surgery & Perioperative Care, University of Texas at Austin Dell Medical School, Austin, Texas.
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Bozic
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
authors.forename: John J
authors.initials: JJ
authors.lastname: Callaghan
mesh_terms: D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000191:economics / Q000627:therapeutic use; D019645:Arthroplasty, Replacement, Knee / Q000191:economics*; D001363:Awards and Prizes; D005260:Female; D017048:Health Care Costs; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage / Q000191:economics; D007719:Knee Joint / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009985:Orthopedics / Q000191:economics; D020370:Osteoarthritis, Knee / Q000191:economics* / Q000601:surgery*; D026741:Physical Therapy Modalities / Q000191:economics; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D006820:Hyaluronic Acid
keywords: clinical practice guidelines; costs; knee osteoarthritis; total knee arthroplasty; value