Total Knee Replacement Seems Cost-Effective for Morbidly Obese with Knee OA

By Amy Orciari Herman

NEJM Journal Watch

Total knee replacement appears to be cost-effective for adults with morbid obesity and knee osteoarthritis (OA), an Annals of Internal Medicine study finds.

Researchers used a microsimulation model to assess the cost-effectiveness of total knee replacement in adults aged 50-65 or 66 and older with a body-mass index of 40 or higher, end-stage knee OA, and numerous comorbidities. The model factored in the greater preoperative pain — and thus greater pain relief from knee replacement — that morbidly obese patients experience, as well as their higher rate of perioperative complications.

Total knee replacement was found to be cost-effective in both age groups, even in those with diabetes, cardiovascular disease, or both.

The authors caution: “In deciding whether to operate, patients and physicians should be fully informed and should carefully weigh the potential improvements in the patient’s [quality of life] against possible surgical risks. Patient safety concerns should take precedence over our cost-effectiveness findings because the cost-effectiveness of a procedure does not imply reduced risk for perioperative complications.”