With the number of joint replacement procedures growing at an extraordinary rate, putting extreme pressure on health care costs that are already on the rise, the health care community must ensure that it is adequately equipped to meet the demand by preparing for rising costs and making sure there are enough orthopedic surgeons. to handle new cases. For their part, medical device companies must design and manufacture implants with a longer lifespan to avoid revision surgeries that increase healthcare costs, while exploring alternatives to traditional joint replacement procedures.

The record growth in joint replacement surgeries represents a lucrative opportunity for implant manufacturers, but with the opportunity comes the responsibility to help contain increases in healthcare costs before they overwhelm our collective ability to pay. Medical device companies are developing new materials and procedures and working with healthcare providers on preventative measures. Still, more needs to happen to prevent joint replacement surgeries from putting a strain on the healthcare system.

Joint replacements, which have been done since the late 1960s, can be very successful in relieving pain, repairing damage caused by arthritis, and helping people function normally and stay active. According to the National Center for Health Statistics, about 43 million Americans, or nearly one in five adults, have some form of arthritis pain. The knees, the largest joints in the body, are often the most painful. Since obesity is also very prevalent, cases of arthritis begin to appear at a much earlier age in overweight people.

The number of replacements skyrockets

With an aging generation of baby boomers, it should come as no surprise that the number of hip and knee replacement procedures has skyrocketed. The National Inpatient Sample (NIS) shows that primary hip replacements increased by 48%, from 153,080 procedures in 1997 to 225,900 in 2004. First-time knee replacements increased by 63% from 264,331 in 1997 to 431,485 in 2004. According to HCUPNet, 228,332 patients received total hip replacements in 2006, and 496,077 patients received total knee replacements.

If these trends continue, an estimated 600,000 hip replacements and 1.4 million knee replacements will take place in 2015. It is estimated that by 2030, the number of knee replacements will increase to more than 3.4 million. Replacement procedures for the first time have increased equally for men and women; however, the number of procedures has increased at particularly high rates among people aged 45 to 64 years.

According to the 2006 Datamonitor report, the US accounts for 50% and Europe for 30% of all procedures worldwide. 2005 hip implant revenue in the US was $ 2 billion and $ 1.4 billion in Europe, while knee implant revenue comprised $ 2.4 billion in the US And $ 774 million in Europe.

Demand and technology drive cost increases

With increasing demand and improvement for implant materials and surgical techniques, the cost of these procedures is also increasing. According to NIS, Medicare was the main source of payment in 2004 (55.4% for primary hip replacements, 59.3% for primary knee replacements). Private insurance payments experienced a more pronounced increase. In 2004, the national bill for hip and knee replacements was $ 26 billion. The hospital cost represented $ 9.1 billion and the reimbursement amount was $ 7.2 billion (28% of hospital charges or 79% of hospital cost).

Another Exponent, Inc. study looked at Medicare data for hip and knee replacements between 1997 and 2003. It was found that while procedural fees increased, reimbursements actually decreased over the study period, and they were observed higher charges for revisions than for primary replacements. The reimbursements per procedure were 62-68% less than the associated charges for the primary and review procedures. Clearly, joint replacements have the potential to be very lucrative, but the burden on patients and our healthcare system must also be considered.

Behind the growth trend

The aging of the population and the increase in the incidence of obesity are the main causes of the increase in joint replacements. Almost 65% of the US population is overweight, and arthritis is highly prevalent in this group. With more patients receiving joint replacements at a younger age, there is a much greater chance that they will survive their artificial joint.

A recent study in Wales tracked joint replacement procedures back to 2003 and found a revision rate of 1 in 75, which was considered a pretty good score. In the US, 40,000 knee reviews and 46,000 hip reviews were performed in 2004. However, knee reviews are expected to increase sevenfold and hip reviews to more than double by 2030.

Revision surgeries are problematic for a number of reasons. In addition to the additional recovery time for patients, revisions are more difficult operations that take longer and cost more. There is often a small amount of bone to place the new implant and the complication rate is much higher.

Why implants fail

With hip replacements, the most common problems are postoperative instability and repeated dislocations. Surgeons must consider many risk factors before initial surgery, including age, gender, motor function disorders, dementia, and previous hip surgery. The surgical approach can also affect the risk of dislocation and leg length discrepancy, so proper preoperative planning is imperative.

The design and positioning of components can also contribute to instability. Dislocations are often caused by movements outside the normal range of motion, so it is important that patients take proper precautions after surgery. A Mayo Clinic study showed that in the case of repeat dislocations, hospital fees for treatment and revision surgery end up costing, on average, 148% of the cost of the initial replacement. The decision to undergo revision surgery is usually made based on repeated dislocations and the health of the patient. Patients who have undergone previous hip surgeries or have poor abductor muscles are at higher risk of failed revisions.

Knee replacement revisions may be required when patients experience infection, osteolysis, implant loosening or misalignment, knee injury, or chronic progressive joint disease. Decisions to undergo screenings are made based on previous knee surgeries, current health, and radiographic examinations. Patients with poor bone quality, unresolved infection, peripheral vascular disease, or poor quadriceps muscles or extensor tendons are at increased risk of a failed revision.

Precautionary measures

With the unprecedented growth of replacement procedures, steps must be taken to prevent this phenomenon from overwhelming our healthcare system. This can be accomplished through better preventive care, alternatives to total replacements, and ensuring that primary replacements are successful. Reducing obesity and treating arthritis in the early stages will help reduce the number of procedures. Additionally, many have called for a national joint replacement registry, such as those in Australia, Great Britain, Norway, Denmark, and Sweden, which track the high failure rates associated with some joint replacement procedures.

Alternative procedures are available that have improved dramatically over the last 10 years. For example, partial replacements are less invasive, with smaller scars and shorter healing times because only diseased compartments are replaced. Minimally invasive procedures for total replacements are available in some patients. There are also new options available for women who need a total knee replacement, known as “gender specific” knees that are slimmer and more contoured to more closely mimic the female anatomy. Hip resurfacing is another procedure that is gaining popularity because it preserves more bone than a traditional total hip replacement. This type of implant will last longer than a traditional hip replacement.

New biomaterials and component designs also increase implant life, and computer-assisted surgery can improve joint replacement success by allowing more precise and precise implant alignment. Several studies have shown that this type of procedure is more cost-effective by avoiding the need for revision.

Looking to the future

For medical device companies, the record growth in joint replacement procedures presents a lucrative opportunity. However, manufacturers must work with the medical community to help ease the burden of this epidemic by increasing the success and longevity of their implants and exploring alternatives to traditional joint replacement procedures.

Without doubt, national arthroplasty registries have proven useful in other countries. The medical community should demand that a registry be established in the United States, and should do a better job of educating society about prevention. It is important that the medical community, including device companies, join a plan to prevent the potential burden that this overwhelming surgical burden could have before it affects our healthcare system.