| With the number of joint replacement procedures | | | | revisions are expected to increase sevenfold, and hip |
| growing at extraordinary rates, putting extreme | | | | revisions to more than double by 2030. |
| pressure on already rising healthcare costs, the | | | | Revision surgeries are problematic for several |
| healthcare community must ensure that it is | | | | reasons. In addition to the extra recovery time for |
| adequately equipped to meet the demand by | | | | patients, revisions are tougher operations that take |
| preparing for the rising costs and making sure that | | | | longer and cost more. There is often a reduced |
| there are enough orthopedic surgeons to handle new | | | | amount of bone to place the new implant and there |
| cases. For their part, medical device companies need | | | | is a much higher complication rate. |
| to design and manufacture implants with longer life | | | | Why Implants Fail |
| spans to avoid revision surgeries that add to | | | | With hip replacements, the most common problems |
| healthcare costs, while exploring alternatives to | | | | are postoperative instability and repeated dislocations. |
| traditional joint replacement procedures. | | | | Surgeons must consider many risk factors before the |
| Record growth in joint replacement surgeries | | | | initial surgery, including age, gender, motor function |
| represents a lucrative opportunity for implant makers, | | | | disorders, dementia and prior hip surgery. The surgical |
| but with opportunity comes the responsibility to help | | | | approach can also affect the risk for dislocation and |
| hold down increases in healthcare costs before they | | | | leg-length discrepancy, so proper pre-operative |
| overwhelm our collective ability to pay. Medical device | | | | planning is a must. |
| companies are developing new materials and | | | | Components design and positioning may also |
| procedures and working with healthcare providers on | | | | contribute to instability. Dislocations are often caused |
| preventive measures. Even so, more needs to | | | | by movement outside the normal range of motion, |
| happen to prevent joint replacement surgeries from | | | | so it is important for patients to take the proper |
| overburdening the healthcare system. | | | | precautions following surgery. A study by the Mayo |
| Joint replacements, which have been performed since | | | | Clinic showed that in the case of repeated |
| the late 1960s, can be highly successful at relieving | | | | dislocations, the hospital fees for treatment and |
| pain, repairing damage caused by arthritis, and helping | | | | revision surgery end up costing, on average, 148% |
| people to function normally and remain active. | | | | of the cost of the initial replacement. The decision to |
| According to the National Center for Health Statistics, | | | | undergo a revision surgery is typically made based on |
| about 43 million Americans, or nearly one in five | | | | repeated dislocations and the patient's health. Patients |
| adults, have some sort of arthritis pain. Knees, the | | | | that have undergone previous hip surgeries or have |
| largest joints in the body, are usually the most painful. | | | | poor abductor muscles are at greater risk for failed |
| Since obesity is also highly prevalent, cases of | | | | revisions. |
| arthritis are beginning to onset at a much earlier age | | | | Revisions of knee replacements may be required |
| in overweight people. | | | | when patients experience infection, osteolysis, |
| Number of Replacements Skyrocketing | | | | implant loosening or misalignment, knee injury or |
| With an aging baby-boomer generation, it should | | | | chronic progressive joint disease. Decisions to |
| come as no surprise that the number of hip and knee | | | | undergo revisions are made based on previous knee |
| replacement procedures have skyrocketed. The | | | | surgeries, current health and radiographic |
| Nationwide Inpatient Sample (NIS) shows that | | | | examinations. Patients with poor bone quality, |
| primary hip replacements increased by 48%, from | | | | unresolved infection, peripheral vascular disease or |
| 153,080 procedures in 1997 to 225,900 in 2004. | | | | poor quadriceps muscles or extensor tendons are at |
| First-time knee replacements grew by 63% from | | | | greater risk for a failed revision. |
| 264,331 in 1997 to 431,485 in 2004. According to | | | | Preventive Measures |
| HCUPNet, 228,332 patients received total hip | | | | With the unprecedented growth in replacement |
| replacements in 2006, and 496,077 patients received | | | | procedures, measures must be taken to prevent this |
| total knee replacements. | | | | phenomenon from overwhelming our healthcare |
| If these trends continue, an estimated 600,000 hip | | | | system. This can be accomplished through better |
| replacements and 1.4 million knee replacements will be | | | | preventive care, alternatives to total replacements, |
| carried out in 2015. It is estimated that by 2030, the | | | | and by ensuring that primary replacements are |
| number of knee replacements will rise to more than | | | | successful. Reducing obesity and treating arthritis at |
| 3.4 million. First-time replacement procedures have | | | | earlier stages will help reduce the numbers of |
| been increasing equally for males and females; | | | | procedures. In addition, many have called for a |
| however, the number of procedures has increased at | | | | national joint replacement registry such as those in |
| particularly high rates among people age 45-64 years. | | | | Australia, Great Britain, Norway, Denmark, and |
| According to Datamonitor's 2006 report, the US | | | | Sweden, which track high failure rates associated |
| accounts for 50% and Europe 30% of the total | | | | with some joint replacement procedures. |
| procedures worldwide. The 2005 revenues for hip | | | | Alternative procedures are available that have |
| implants in the US were $2 billion and $1.4 billion in | | | | improved dramatically over the past 10 years. For |
| Europe, while knee implant revenues comprised $2.4 | | | | example, partial replacements are less-invasive, with |
| billion in the US and $774 million in Europe. | | | | smaller scars and shorter healing times because only |
| Demand & Technology Drive Cost Increases | | | | the diseased compartments are replaced. Minimally |
| With the increase in demand and improved implant | | | | invasive procedures are available for total |
| materials and surgical techniques, the cost of these | | | | replacements in some patients. There are also new |
| procedures is also increasing. According to NIS, | | | | options available for women needing total knee |
| Medicare was the major source of payment in 2004 | | | | replacement, known as "gender-specific" knees that |
| (55.4% for primary hip replacements, 59.3% for | | | | are slimmer and contoured to more closely imitate |
| primary knee replacements). Private insurance | | | | the female anatomy. Hip resurfacing is another |
| payments experienced a steeper increase. In 2004, | | | | procedure gaining in popularity because it conserves |
| the national bill for hip and knee replacements was | | | | more bone than a traditional total hip replacement. |
| $26 billion. Hospital cost accounted for $9.1 billion, and | | | | This type of implant will last longer than a traditional |
| the amount of reimbursement was $7.2 billion (28% | | | | hip replacement. |
| of hospital charges or 79% of hospital cost). | | | | New biomaterials and component designs also |
| Another study from Exponent, Inc. analyzed Medicare | | | | increase the lifespan of implants, and |
| data for hip and knee replacements from 1997-2003. | | | | computer-assisted surgery can improve the success |
| It was found that while procedural charges increased, | | | | of joint replacement by allowing more accurate and |
| reimbursements actually decreased over the study | | | | precise implant alignment. Several studies have shown |
| period, with higher charges observed for revisions | | | | this type of procedure to be more cost-effective by |
| than primary replacements. Reimbursements per | | | | preventing the need for revision. |
| procedure were 62-68% less than associated | | | | Looking Ahead |
| charges from primary and revision procedures. It is | | | | For medical device companies, the record growth in |
| evident that joint replacements have the potential to | | | | joint replacement procedures presents a lucrative |
| be highly lucrative, but the burden on patients and | | | | opportunity. However, manufacturers need to work |
| our healthcare system must also be considered. | | | | with the medical community to help ease the burden |
| Behind the Growth Trend | | | | of this epidemic by increasing the success and |
| An aging population and increased incidence of | | | | longevity of their implants and exploring alternatives |
| obesity are primary causes for the increase in joint | | | | to the traditional joint replacement procedures. |
| replacements. Nearly 65% of the US population is | | | | Undoubtedly, national joint replacement registries |
| overweight, and arthritis is highly prevalent among | | | | have proven useful in other countries. The medical |
| this group. With more patients receiving joint | | | | community needs to demand that a registry be put |
| replacements at an earlier age, there is much higher | | | | in place in the United States, and it needs to do a |
| probability they will outlive their artificial joint. | | | | better job of educating society on prevention. It is |
| A recent study in Wales tracked joint replacement | | | | important that the medical community, including |
| procedures since 2003 and found a revision rate of | | | | device companies, come together with a plan for |
| 1-in-75, which was considered to be a fairly good | | | | preventing the potential burden this overwhelming |
| score. In the US, 40,000 knee revisions and 46,000 | | | | surgical load could have before it takes a toll on our |
| hip revisions were performed in 2004. However, knee | | | | healthcare system. |