News Release

Total knee replacement cost effective for patients with osteoarthritis and extreme obesity

Embargoed news from Annals of Internal Medicine

Peer-Reviewed Publication

American College of Physicians

Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.

1. Total knee replacement cost-effective for patients with osteoarthritis and extreme obesity


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Total knee replacement (TKR) surgery is cost-effective in patients with severe obesity (BMI of 40Kg/m2 or greater) and end-stage osteoarthritis. Typically, surgeons hesitate to perform TKR in these patients because they tend to have high rates of complications post-surgery. Findings from a cost-effectiveness analysis are published in Annals of Internal Medicine.

Obesity is a major risk factor for knee osteoarthritis, which affects more than 14 million adults in the United States. As such, a growing proportion of patients receiving TKR are obese (BMI of 30 kg/m2 or higher). In fact, 45.5% of TKR recipients in 2006 to 2010 had a BMI between 30 and less than 40 kg/m2, and 14.8% had a BMI of 40 kg/m2 or greater. While TKR has been shown to be very effective and cost-effective in non-obese patients with end-stage knee OA in the US, the question of whether or not TKR is cost-effective in this population has not been addressed.

Researchers from Brigham and Women's Hospital used the Osteoarthritis Policy (OAPoL) model to assess the value of TKR in recipients with extreme obesity across two age strata - younger or older than 65 as well as in the presence and absence of two major comorbidities - cardiovascular disease and diabetes, that has been shown to increase the risk of perioperative complications. The researchers took into consideration higher rates of complications and pain reduction in patients with extreme obesity. They found that TKR was a cost-effective strategy for patients aged 50 to 65 years with severe obesity and for patients older than 65 years, as well. Similar findings were noted for TKR among patients with extreme obesity and end-stage knee osteoarthritis in the presence of cardiovascular disease and/or type 2 diabetes. The researchers concluded that from a cost-effectiveness perspective, TKR leads to substantial improvements in quality-adjusted life expectancy and offers a good value in patients with extreme obesity and end-stage knee osteoarthritis.

Media contacts: For an embargoed PDF, please contact Angela Collom at The corresponding author, Elena Losina, PhD, can be reached through Haley Bridger at

2. Increasing primary care physicians could boost life expectancy, reduce deaths in underserved areas


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Increasing the number of primary care physicians in underserved areas could prevent more than 7,000 deaths per year in those areas and boost life expectancy by an average of 56 days. To achieve such gains in death prevention and life expectancy, the U.S. physician workforce would need to add 95,754 new physicians to its ranks and allocate them in shortage areas. Findings from a modeling study are published in Annals of Internal Medicine.

Studies have shown that having a greater number of primary care physicians per population is associated with reduced population mortality. For this reason, addressing the primary care shortage is a public health priority. A shortage is defined as having fewer than 1 primary care physician per 3,500 residents in an area.

Researchers from Harvard Medical studied population health data for 3,400 U.S. counties to estimate how alleviating PCP shortages might change life expectancy and mortality. They found that individuals who lived in counties with more acute shortages had an average life expectancy that was 311 days shorter than individuals living in counties with more primary care physicians. The gap in life expectancy grew wider--629 days--when researchers compared counties with 1 primary-care doctor per 1,500 individuals and counties with fewer than one primary care physician per 1,500 people.

According to the researchers, these findings underscore the need for increasing access to primary care by encouraging physicians to consider practices in underserved regions of the country.

Media contacts: For an embargoed PDF, please contact Angela Collom at The corresponding author, Sanjay Basu, MD, PhD, can be reached through Ekaterina Pesheva at

Also in this issue:

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Ideas and Opinions


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