Majority of costly knee replacements could be avoided with physiotherapy

Knee and hip replacement surgeries were the most expensive claim items in 2018 for Bupa, but experts warn most surgeries could be avoided if patients explored physiotherapy as a first line of care. Source: Shutterstock

While hip and knee replacements get thousands of Australians back on their feet and help to relieve them of debilitating pain each year, new research claims that the number of people undergoing these surgeries could be drastically lowered by physiotherapy.

A report released on Tuesday by healthcare company Bupa shows health insurance claims for knee and hip replacement surgeries totalled more than $420 million in 2018, making them the most expensive items paid out for over the year.

However, according to the Australian Physiotherapy Association (APA), a physiotherapy prescribed exercise and education program and weight management support could actually avert more than 70 per cent of knee replacement surgeries alone which could result in savings of $300 million annually.

“Physio research has highlighted the enormous costs of knee and hip replacement surgeries and the subsequent cost saving that could be made by having consumers see a physiotherapist for review before surgery is scheduled,” APA National President Phil Calvert said in a statement.

“It is international best practice for all patients to be referred to physiotherapy as a first line of care whether they are suffering from mild or severe osteoarthritis, which is the biggest cause of knee and hip replacement surgeries in Australia.”

There are now calls for better management of patient care and cost expenditure, with experts encouraging the health insurance system to work together to deliver a sustainable system.

“If we want to be able to put downward pressure on health insurance premiums, we need to be able to trial different ways of delivering healthcare which don’t affect quality of care but may reduce cost or give patients more choice,” Bupa Health Insurance Managing Director Dr Dwayne Crombie said.

“This includes continuing to look at why prosthetics for hips and knees cost significantly more in Australia than other parts of the world.”

He also explained that while the current mindset is that a person needs to stay in hospital for rehabilitation after a knee or hip replacement, evidence shows that the outcome is the same or better if done in their home.

“It also means understanding that surgery for many of these conditions could be avoided if appropriate preventative health measures, including weight management, are appropriately promoted and funded,” Crombie added. “We’re keen to have these discussions, to work with clinicians to see people getting the right care, in the right place, at the right time and for the right price.”

There are also calls for the cost burden on consumers who opt for non-surgical approaches to be lessened and for Medicare subsidies to encourage a physio-first approach.

“Currently, consumers have to pay more out of their own pockets when they take up an early intervention management program for their OA [osteoarthritis] by pro-actively seeking appropriate physio care,” Calvert said. “Yet if they choose surgery as a first option – which we are clearly seeing all too often judging by these Bupa payout figures – their knee or hip replacement surgery is fully funded via their hospital cover. This just does not make sense.”

The report shows that the high number of hip and knee replacements is due to the ageing population and more people becoming overweight. Other procedures that topped Bupa’s most expensive claims for 2018 included lens procedures, spinal fusion, interventional coronary procedures and cardiac pacemaker implantation.

“These are all very good and very useful procedures. They are helping us live longer lives and have better quality of life,” Crombie explained. “But many of these operations are symptomatic of people getting older and more of the population being overweight or obese.

He added: “Greater access to more sophisticated technology to improve health outcomes should be celebrated, but we need to understand that these advances come with increased costs.”

Have you had a hip or knee replacement? Where you offered physiotherapy before surgery?

Important information: The information provided on this website is of a general nature and information purposes only. It does not take into account your personal health requirements or existing medical conditions. It is not personalised health advice and must not be relied upon as such. Before making any decisions about your health or changes to medication, diet and exercise routines you should determine whether the information is appropriate in terms of your particular circumstances and seek advice from a medical professional.

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