{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:48:09Z","timestamp":1787755689417,"version":"build-2784847793"},"reference-count":22,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"19","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,10,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The convergence of national priorities to reduce health-care costs and deliver high-value care warrants the need to examine health-care utilization. The objective of this study was to describe the costs associated with nonoperative procedures in the 1-year period leading up to primary total knee arthroplasty (TKA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>An observational cohort study was conducted using the IBM Watson Health MarketScan databases. Patients with late-stage knee osteoarthritis (OA) who underwent unilateral, isolated primary TKA from January 1, 2018, to December 31, 2019, were included. The main outcome was the cost of knee OA-related payments for identified nonoperative procedures in the 1-year period before surgery. Nonoperative procedures examined were (1) physical therapy (PT); (2) bracing; (3) intra-articular injections: professional fee, hyaluronic acid (IA-HA), and corticosteroids (IA-CS); (4) medication: nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, and acetaminophen; and (5) knee-specific imaging.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The study population included 24,492 TKA patients with a mean age of 60.4 \u00b1 8.0 years. The average total cost of nonoperative procedures per patient was $1,355 \u00b1 $2,087. The most common nonoperative treatment prescribed was IA-CS (54.3%). The nonoperative procedure with the highest cost per patient was IA-HA ($1,019 \u00b1 $913 per patient). The total cost of nonoperative procedures was higher among female compared with male patients ($1,440 \u00b1 $2,159 versus $1,254 \u00b1 $1,992 per patient; p &lt; 0.01). The highest costs were found for patients in the Northeast ($1,740 \u00b1 $2,437 per patient). A total of 14,346 (58.6%) and 7,831 (32.0%) of the patients had &gt;1 and \u22653 nonoperative treatments, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>There is substantial variation in the type and the cost of nonoperative treatment for patients with late-stage OA. Future studies should investigate the effectiveness of nonoperative treatments at different stages of the disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level III<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.21.01415","type":"journal-article","created":{"date-parts":[[2022,9,20]],"date-time":"2022-09-20T14:15:50Z","timestamp":1663683350000},"page":"1697-1702","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":15,"title":["Costs of Nonoperative Procedures for Knee Osteoarthritis in the Year Prior to Primary Total Knee Arthroplasty"],"prefix":"10.2106","volume":"104","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6843-863X","authenticated-orcid":false,"given":"Darren Z.","family":"Nin","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts"},{"name":"Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3149-9871","authenticated-orcid":false,"given":"Ya-Wen","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carl T.","family":"Talmo","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2946-9278","authenticated-orcid":false,"given":"Brian L.","family":"Hollenbeck","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, New England Baptist Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8285-459X","authenticated-orcid":false,"given":"David A.","family":"Mattingly","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2485-0192","authenticated-orcid":false,"given":"Ruijia","family":"Niu","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1414-1280","authenticated-orcid":false,"given":"David C.","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts"},{"name":"Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1609-7639","authenticated-orcid":false,"given":"Eric L.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2022,9,20]]},"reference":[{"issue":"12","key":"bib1-20250430","doi-asserted-by":"crossref","first-page":"1743","DOI":"10.1002\/acr.22897","article-title":"Number of persons with symptomatic knee osteoarthritis in the US: Impact of race and ethnicity, age, sex, and obesity","volume":"68","author":"Deshpande","year":"2016","journal-title":"Arthritis Care Res (Hoboken)."},{"issue":"1","key":"bib2-20250430","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1002\/art.23176","article-title":"Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. 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