Patterns in the Use and Cost of Medical Care for Osteoarthritis Prior to Total Knee Arthroplasty: An Analysis of the Osteoarthritis Initiative and Medicare Data

In this paper, we examined patterns in the use and costs of treatments for osteoarthritis (OA) of the knee in the years prior to total knee arthroplasty (TKA) and how these patterns differ between elderly and younger populations.  We examined treatments from one to five years prior to surgery for a cohort of individuals with osteoarthritis who received a TKA.    Using data from the Osteoarthritis Initiative and Medicare, we assessed the use of medications, corticosteroid and hyaluronic acid injections, arthroscopy, durable medical equipment, and office visits.  We found that the use and spending for services related to knee OA increased every year leading up to total knee arthroplasty, increasing almost 9 fold between one year prior to TKA and five years prior to TKA. Patients in our sample generated more spending on hyaluronic acid and corticosteroid injections than any other treatment category. The injections represented between 28.7% (five years prior to TKA) and 44.9% (two years prior to TKA) of the Medicare spending related to knee OA.  Nevertheless, use rates for most services remained relatively low, with the exception of pain-relieving medications.

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