A panel charged with reviewing all of the available evidence on total knee replacement (TKR) found that for persons suffering from intractable and persistent knee pain and disability, TKR surgery is a safe and cost-effective therapy that restores mobility and alleviates discomfort. Over 20 years of follow-up data indicate that the procedure is successful in the vast majority of patients.

The panel reported that there is clear evidence of racial, ethnic, and gender disparities in the provision of total knee replacements, as there is for many other health care interventions, but the reasons for this are unclear. Physicians' beliefs about their patients, limited familiarity with these procedures in minority communities, and patient mistrust of the health care system may all have a role. The consensus panel is calling for more research to determine the causes of these disparities.

"TKR is not for everyone-it's major elective surgery that carries a variety of important risks, but it often offers dramatic relief after other therapies fail," said the panel chair, orthopaedic surgeon Dr E Anthony Rankin of Providence Hospital in Washington DC. The panel emphasized that for patients considering TKR, important factors to consider include surgeon and hospital volume of TKRs performed, as these are associated with lower complication rates. Dr Rankin explained, "Basically, the more they do, the better they do it."

Loosening of the implant is the main cause of failed total knee prostheses that necessitate revision procedures, and that proper alignment of the prosthesis is critical to minimizing long-term wear and loosening of the implant. The panel noted that computer navigation may eventually reduce the risk of substantial malalignment, but the technology is as yet unproven and its cost may be prohibitive for many hospitals.

The 11-member panel included practitioners and researchers in orthopaedics, rheumatology, internal medicine, nursing, physical therapy, rehabilitation, biostatistics, epidemiology, and health services research, as well as a TKR patient. The conference brought together experts in a range of relevant disciplines to present the latest research in current TKR practice and outcomes to the consensus panel. The panel reviewed an extensive collection of medical literature related to TKR, including a systematic literature review prepared by the Minnesota Evidence-Based Practice Center, under contract with the Agency for Healthcare Research and Quality (AHRQ).