Severe Knee Pain Linked With Less Willingness to Undergo TKR Among Uninsured Patients

Severe Knee Pain Linked With Less Willingness to Undergo TKR Among Uninsured Patients

Among the uninsured, severe knee pain was associated with less willingness to undergo a total knee replacement, according to recently published findings.

“Despite being a beneficial and cost-effective procedure, knee replacement surgery is underutilized in the [United States] U.S., especially among certain populations, such as racial minorities,” Ernest R. Vina, MD, MS, assistant professor of medicine at the University of Arizona College of Medicine, told Healio Rheumatology. “Patient willingness to undergo joint replacement surgery strongly influences eventual receipt of the procedure. Patients without medical insurance, though, are less willing to undergo knee replacement despite having severe knee pain.”

Ernest R. Vina, MD, MS

Ernest R. Vina

Vina and colleagues conducted a cross-sectional analysis of 3,530 participants among the Osteoarthritis Initiative. The researchers used logistic regression models to assess knee pain severity on willingness to undergo total knee replacement. They also assessed whether socioeconomic status or health care coverage had an effect.

Compared with participants without knee pain, those with pain were less willing to undergo total knee replacement (odds ratio = 0.73). However, the association weakened (odds ratio = 0.92) after the researchers adjusted for age, sex, comorbidity, depression, health insurance coverage, prescription coverage, health care source, education, income, employment, race and marital status.

After comparing those with the highest level of pain to those with the lowest, investigators found a significant decrease in willingness to undergo surgery (adjusted odds ratio = 0.08), but not among those who were insured (adjusted odds ratio = 1.03) after adjusting for demographic, clinical, health care access and socioeconomic factors. Fewer than 5% of participants were uninsured.

The most cited reason by the uninsured for why they do not receive necessary care was inability to pay, the researchers wrote. In 2008, “the estimated knee implant cost per case ranged from $1,797 to $12,093,” they wrote.

The researchers concluded policies that improve health care access may increase total knee replacement surgery usage among these populations.

“This suggests that policies that improve access to health care may increase patient preference towards a highly beneficial procedure in people who need them (ie, knee osteoarthritis patients),” Vina said. – by Will Offit

Disclosure: The researchers report no relevant financial disclosures.