SPECIAL REPORT: Wasted knee treatments
Tom Akin has built a successful career selling high end cars. But all of that standing and walking caused too much wear and tear on his left knee. "Finally when I got to 2004, I was working at a dealership in Iowa City, and the angle of the parking lot was so sloped. So as you'd walk around all day, my knee would swell up and swell up." Akin says.
By 2004 - Tom had already spent money on a scope of his knee plus medication. Neither of them worked.
Then, he found Dr. John Callaghan, a hip and knee surgeon, author, and professor at the University of Iowa. Dr. Callaghan diagnosed osteoarthritis of the knee, and performed a total knee revision for Tom.
Surgeries like his can cost around 50-thousand dollars, and while insurance does cover nearly all of it, patients are left to foot a small part of the bill.
Tom followed his post-op exercises to a tee and was back at work in no time. He says, "Walking in my job, the retail auto business, is excellent for rehab because you walk all day long, in and out, and I found that within a short time, my knee was to the point that I really didn't know I had the operation."
According to the Centers for Disease Control, many older Iowans suffer from arthritis. In 2015 alone, more than 600-thousand Iowans were diagnosed with the condition. More than half of them - age 65 and up. It's an expensive problem too - especially if you are on a fixed income.
Research done by Dr.Callaghan and colleagues at the U of I looked at 86-thousand knee arthritis patients, within their final year before a total knee revision surgery. Dr. Nic Bedard says of those patients, the total cost of their treatments reached 43-million dollars. "If you look at all of the cost of knee arthritis during that one year period, about one-third of that, or 30%, was being used for hyaluronic acid injections in the knee, which have a strong recommendation against their use in these guidelines." Bedard replied. Dr. Bedard says hyaluronic acid injections are among five treatments shown in the study not to work as well as others, or not to work at all. In addition to hyaluronic acid injections, the less effective treatments are steroid injections, knee braces, special insoles, and various opiod drugs. Three other treatments were found to be far more effective for patients. They are physical therapy, non steroidal anti-inflammatory drugs such as ibuprofen, and one specific opiate called tramadol.
Light exercise like walking is great for keeping knees healthy. But if you notice pain or stiffness, take the advice of one patient who says to see your doctor right away. "I kept putting it off and putting it off and putting it off until finally, I could hardly walk on that knee anymore." says Jack Kirik. Kirik's knee problems began when he was a boy, playing softball in 4th grade. The batter in front of him struck out. "He was really ticked." Kirik exclaimed, "and I'm up next so I'm coming to get the bat from him, and he's swinging the bat like this, and boom, right into my knee! And I went down like a ton of bricks." But jack needed his knees more than ever. The oldest of five children with a father who worked in a factory, his only chance for college rested on his two legs. Jack went to Columbia University in New York city on a football scholarship. He played quarterback. But during his sophomore year, his old knee injury flared up again. A doctor told Jack to quit the team to spare his knee. The doctor said, "Jack you'd better quit playing football. You're going to have trouble." Determined to graduate, Jack ignored that advice. He says, "I kept on playing. I paid the price, but, I'd do it all over again!"
In March of 2002, Dr.Callaghan performed what would be Jack's fifth, and hopefully final, knee surgery. He says the U of I study makes guidelines for treating knee arthritis much more clear so that patients get the most for their money. "We're giving them the knowledge that they need to make a better, conscientious decision, especially one that has value to them and to the system without being excessive in cost." Dr. Callaghan says.
He adds that surgery is not a solution for every patient, but it can be life changing, under the right circumstances. The study from UI will be published in the September Journal of Arthroplasty. Click here for more information.