NIH Consensus Panel Confirms Effectiveness of Total Knee Replacement

Bethesda, Maryland �� A panel charged with reviewing all of the available evidence on total knee replacement (TKR) today found that for persons suffering from intractable and persistent knee pain and disability, TKR surgery is a safe and cost-effective therapy that restores mobility and alleviates discomfort. Over 20 years of follow-up data indicate that the procedure is successful in the vast majority of patients.

The panel reported that there is clear evidence of racial, ethnic, and gender disparities in the provision of total knee replacements, as there is for many other health care interventions, but the reasons for this are unclear. Physicians beliefs about their patients, limited familiarity with these procedures in minority communities, and patient mistrust of the health care system may all have a role. The consensus panel is calling for more research to determine the causes of these disparities.

TKR is not for everyone �� its major elective surgery that carries a variety of important risks, but it often offers dramatic relief after other therapies fail, said the panel chair, orthopaedic surgeon Dr. E. Anthony Rankin of Providence Hospital in Washington, D.C. The panel emphasized that for patients considering TKR, important factors to consider include surgeon and hospital volume of TKRs performed, as these are associated with lower complication rates. Dr. Rankin explained, Basically, the more they do, the better they do it.

Loosening of the implant is the main cause of failed total knee prostheses that necessitate revision procedures, and that proper alignment of the prosthesis is critical to minimizing long-term wear and loosening of the implant. The panel noted that computer navigation may eventually reduce the risk of substantial malalignment, but the technology is as yet unproven and its cost may be prohibitive for many hospitals.

These findings are part of the panels consensus statement, presented at the close of this three-day consensus development conference. The NIH Office of Medical Applications of Research (OMAR) and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), components of the U.S. Department of Health and Human Services, sponsored the conference. Cosponsors included the National Institute of Child Health and Human Development (NICHD), the U.S. Food and Drug Administration (FDA), the National Institute of Standards and Technology (NIST) and the NIH Office of Research on Womens Health.

The 11-member panel included practitioners and researchers in orthopaedics, rheumatology, internal medicine, nursing, physical therapy, rehabilitation, biostatistics, epidemiology, and health services research, as well as a TKR patient. The conference brought together experts in a range of relevant disciplines to present the latest research in current TKR practice and outcomes to the consensus panel. The panel reviewed an extensive collection of medical literature related to TKR, including a systematic literature review prepared by the Minnesota Evidence-Based Practice Center, under contract with the Agency for Healthcare Research and Quality (AHRQ). A summary of the Evidence Report on Total Knee Replacement is available at http://www.ahrq.gov/clinic/epcix.htm. The full report will be available on-line shortly.

The panels statement is an independent report and is not a policy statement of the NIH or the Federal Government. The NIH Consensus Development Program, of which this conference is a part, was established in 1977 as a mechanism to judge controversial topics in medicine and public health in an unbiased, impartial manner. NIH has conducted 117 consensus development conferences, and 22 state-of-the-science (formerly technology assessment) conferences, addressing a wide range of issues.

The full text of the panels statement will be available in draft form following the conference at http://consensus.nih.gov. The final version will be available at the same web address in three to four weeks. Statements from past conferences and additional information about the NIH Consensus Development Program are also available at the Web site, or by calling 1-888-644-2667.

The archived videocast of the conference sessions will be available shortly at http://consensus.nih.gov/.

Note to Radio Editors: An audio report of the conference results will be available after 4 p.m. December 10, 2003 from the NIH Radio News Service by calling 1-800-MED-DIAL (1-800-633-3425).