Skip to main content
NCBI home page
Health Services Research logoLink to Health Services Research
. 1996 Jun;31(2):125–140.

Demographic variation in the rate of knee replacement: a multi-year analysis.

B P Katz 1, D A Freund 1, D A Heck 1, R S Dittus 1, J E Paul 1, J Wright 1, P Coyte 1, E Holleman 1, G Hawker 1
PMCID: PMC1070109  PMID: 8675435

Abstract

OBJECTIVE. The aim of this study is to describe the practice variation of knee replacements (KRs) in the elderly ( > or = 65) over time from 1985-1990 in terms of the number of primary, bilateral, and revision KRs; the extent of large area variation in performance rates; and the degree to which demographic variables are the determinants of area rates. DATA SOURCES/STUDY SETTING. Data analyzed are from every hospital in the United States that performed a KR on a Medicare patient during the study period. Data were obtained from the MEDPAR, HISKEW, and denominator files of the Medicare Statistical System. STUDY DESIGN. This is a cohort study of all Medicare beneficiaries who received a KR between 1985 and 1990. The dependent variable in the analyses was the count of the KRs performed in each area. DATA COLLECTION/EXTRACTION METHODS. This is a population-based sample of Medicare enrollees in the United States. All hospitalizations for Medicare-reimbursed KRs were included in the initial data set. Exclusion criteria were used to identify the Medicare covered population with a definite KR. These criteria resulted in 7.3 percent exclusions and a final set of 414,079 KR hospitalizations. PRINCIPAL FINDINGS. The number of Medicare-funded KRs increased in each of the study years corresponding to an annual rate of increase of 18.45 percent. The likelihood of receiving a KR was a function of age, gender, and race. For each year, KRs were almost-twice as likely to be performed on women than on men. The odds of whites getting the surgery were over 1.5 times greater than for blacks. Even after adjusting for demographic factors, significant regional variation remained. CONCLUSIONS. Much about area variation and the rate of growth in KR rates remains unexplained. For answers to emerge, better data and different types of studies are required.

Full text

PDF
125

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anderson J. J., Felson D. T. Factors associated with osteoarthritis of the knee in the first national Health and Nutrition Examination Survey (HANES I). Evidence for an association with overweight, race, and physical demands of work. Am J Epidemiol. 1988 Jul;128(1):179–189. doi: 10.1093/oxfordjournals.aje.a114939. [DOI] [PubMed] [Google Scholar]
  2. Ayanian J. Z., Udvarhelyi I. S., Gatsonis C. A., Pashos C. L., Epstein A. M. Racial differences in the use of revascularization procedures after coronary angiography. JAMA. 1993 May 26;269(20):2642–2646. [PubMed] [Google Scholar]
  3. Barry M. J., Mulley A. G., Jr, Fowler F. J., Wennberg J. W. Watchful waiting vs immediate transurethral resection for symptomatic prostatism. The importance of patients' preferences. JAMA. 1988 May 27;259(20):3010–3017. [PubMed] [Google Scholar]
  4. Bradley J. D., Brandt K. D., Katz B. P., Kalasinski L. A., Ryan S. I. Comparison of an antiinflammatory dose of ibuprofen, an analgesic dose of ibuprofen, and acetaminophen in the treatment of patients with osteoarthritis of the knee. N Engl J Med. 1991 Jul 11;325(2):87–91. doi: 10.1056/NEJM199107113250203. [DOI] [PubMed] [Google Scholar]
  5. Chassin M. R., Brook R. H., Park R. E., Keesey J., Fink A., Kosecoff J., Kahn K., Merrick N., Solomon D. H. Variations in the use of medical and surgical services by the Medicare population. N Engl J Med. 1986 Jan 30;314(5):285–290. doi: 10.1056/NEJM198601303140505. [DOI] [PubMed] [Google Scholar]
  6. Felson D. T. Epidemiology of hip and knee osteoarthritis. Epidemiol Rev. 1988;10:1–28. doi: 10.1093/oxfordjournals.epirev.a036019. [DOI] [PubMed] [Google Scholar]
  7. Fleming C., Wasson J. H., Albertsen P. C., Barry M. J., Wennberg J. E. A decision analysis of alternative treatment strategies for clinically localized prostate cancer. Prostate Patient Outcomes Research Team. JAMA. 1993 May 26;269(20):2650–2658. [PubMed] [Google Scholar]
  8. Freund D. A., Dittus R. S., Fitzgerald J., Heck D. Assessing and improving outcomes: total knee replacement. Health Serv Res. 1990 Dec;25(5):723–726. [PMC free article] [PubMed] [Google Scholar]
  9. Hillman A. L., Schwartz J. S. The adoption and diffusion of CT and MRI in the United States. A comparative analysis. Med Care. 1985 Nov;23(11):1283–1294. doi: 10.1097/00005650-198511000-00007. [DOI] [PubMed] [Google Scholar]
  10. Keller R. B., Soule D. N., Wennberg J. E., Hanley D. F. Dealing with geographic variations in the use of hospitals. The experience of the Maine Medical Assessment Foundation Orthopaedic Study Group. J Bone Joint Surg Am. 1990 Oct;72(9):1286–1293. [PubMed] [Google Scholar]
  11. Lu-Yao G. L., McLerran D., Wasson J., Wennberg J. E. An assessment of radical prostatectomy. Time trends, geographic variation, and outcomes. The Prostate Patient Outcomes Research Team. JAMA. 1993 May 26;269(20):2633–2636. doi: 10.1001/jama.269.20.2633. [DOI] [PubMed] [Google Scholar]
  12. Morrey B. F., Adams R. A., Ilstrup D. M., Bryan R. S. Complications and mortality associated with bilateral or unilateral total knee arthroplasty. J Bone Joint Surg Am. 1987 Apr;69(4):484–488. [PubMed] [Google Scholar]
  13. Peterson M. G., Hollenberg J. P., Szatrowski T. P., Johanson N. A., Mancuso C. A., Charlson M. E. Geographic variations in the rates of elective total hip and knee arthroplasties among Medicare beneficiaries in the United States. J Bone Joint Surg Am. 1992 Dec;74(10):1530–1539. [PubMed] [Google Scholar]
  14. Roos N. P. Hysterectomy: variations in rates across small areas and across physicians' practices. Am J Public Health. 1984 Apr;74(4):327–335. doi: 10.2105/ajph.74.4.327. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Roos N. P., Roos L. L., Jr, Henteleff P. D. Elective surgical rates--do high rates mean lower standards? Tonsillectomy and adenoidectomy in Manitoba. N Engl J Med. 1977 Aug 18;297(7):360–365. doi: 10.1056/NEJM197708182970705. [DOI] [PubMed] [Google Scholar]
  16. Salive M. E., Mayfield J. A., Weissman N. W. Patient Outcomes Research Teams and the Agency for Health Care Policy and Research. Health Serv Res. 1990 Dec;25(5):697–708. [PMC free article] [PubMed] [Google Scholar]
  17. Wennberg J. E., Barnes B. A., Zubkoff M. Professional uncertainty and the problem of supplier-induced demand. Soc Sci Med. 1982;16(7):811–824. doi: 10.1016/0277-9536(82)90234-9. [DOI] [PubMed] [Google Scholar]
  18. Wennberg J., Gittelsohn Small area variations in health care delivery. Science. 1973 Dec 14;182(4117):1102–1108. doi: 10.1126/science.182.4117.1102. [DOI] [PubMed] [Google Scholar]
  19. Wenneker M. B., Epstein A. M. Racial inequalities in the use of procedures for patients with ischemic heart disease in Massachusetts. JAMA. 1989 Jan 13;261(2):253–257. [PubMed] [Google Scholar]
  20. Wright J. G., Coyte P., Hawker G., Bombardier C., Cooke D., Heck D., Dittus R., Freund D. Variation in orthopedic surgeons' perceptions of the indications for and outcomes of knee replacement. CMAJ. 1995 Mar 1;152(5):687–697. [PMC free article] [PubMed] [Google Scholar]

Articles from Health Services Research are provided here courtesy of Health Research & Educational Trust

RESOURCES