Reply to the Letter to the Editor: Not the Last Word: Safety Alert: One in 200 Knee Replacement Patients Die Within 90 Days of Surgery
I thank Drs. Berstock and Whitehouse for their interest in the column and for providing additional information about the mortality risks following knee replacement.
There is certainly room for us to debate. We can start with the fact that Hunt and colleagues , the large study Drs. Berstock and Whitehouse cited in their letter, reported on 45-day mortality, not 90-day mortality; the study also included unicompartmental surgery. That is to say, the methods used by Hunt and colleagues  skew the result downward, perhaps to the point of irrelevance regarding the question at hand.
But let's focus on what is not debatable: The risk of death following knee replacement is at least one in 1000, and a risk of that magnitude, when life is on the line, is material and consequential.
I trust that Drs. Berstock and Whitehouse would also agree that more research is needed. If my calculations can be termed “back-of-the-envelope meta-analysis,” then this discussion is “back-of-the-journal-meta-meta-analysis.” Our patients deserve better. The true risk of patient-specific mortality should be easily available, and this information should be shared broadly.