Abstract
Purpose
Great expense is accumulated in investigation and management, often with poor outcome, of a patient with a painful TKR. We aim to produce guidelines for their investigation and careful, successful management.
Method
We studied 42 cases of patients with a painful TKR. Costs were calculated of appointments, serological and radiological investigations for these patients and an average cost of investigating a patient was obtained. We also calculated costs of various forms of management, both surgical and non-surgical and correlated these with patient outcomes.
Results
41 patients with an average investigation time of 20 months had on average 4 Orthopaedic appointments for the investigation of a painful TKR. On average, 8 blood tests were performed along with 8 radiographs. The average cost of investigating a patient with a painful TKR was £2337. 22 patients underwent operative intervention compared to 19 having solely pharmaceutical intervention. There was a significant difference between the amounts spent in each group with £5051 spent per patient in the operative group compared to £190 per patient on the non-operative group. There was a higher percentage of patient improvement in the non-operative group.
Conclusion: Costs for investigation of a patient with a painful TKR were high because of exceedingly high numbers of repeated investigations. There is no guidance currently on how to manage painful TKR which is becoming an increasing clinical problem because of the increasing number of TKR's being performed per year. A lot of money is wasted on over investigating patients and performing operations that do not improve symptoms or prognosis. Careful thought needs to be given to careful investigation and management of patients in order to achieve optimal patient improvement.
We have proposed a protocol for the investigation and management that allows prompt diagnosis and intervention and helps improve symptoms while keeping costs down.
