A Medical Device Daily
The demand for total joint replacement is expected to increase so dramatically in the next 25 years that there may not be enough orthopedic surgeons to perform the surgeries, as indicated by results from recent research on the topic.
As presented at the 73rd annual meeting of the American Academy of Orthopaedic Surgeons (AAOS; Rosemont, Illinois), the study projects the number of hip and knee replacement procedures that will be performed in the U.S. through the year 2030.
Lead author Steven Kurtz, PhD, director of the Philadelphia office of Exponent (Menlo Park, California), an engineering and scientific consulting firm, and his research team projected that the number of procedures for primary (first-time) total knee replacement would jump by 673% – to 3.48 million – in 2030. The number of primary total hip replacements, the authors estimate, will increase by 174% – to 572,000 – in 2030. Partial joint replacements were projected to increase by only 54%. The research team based its projections on historical procedure rates from 1990 to 2003, combined with population projections from the U.S. Census Bureau.
Also expected to become more prevalent is the repair or replacement of the artificial joint, called revision joint replacement. The number of revision surgeries likely will double by 2015 for total knee replacement and by 2026 for total hip replacement, according to the authors. Currently, hip revisions outnumber knee revisions, but knee revisions should surpass hip revisions after 2007, Kurtz said.
“There's definitely going to be a huge need for more orthopedic surgeons,“ said Kurtz, who is also research associate professor at Drexel University 's (also Philadelphia) School of Biomedical Engineering. “If the massive expected demand for total joint replacement is not planned for before 2030, patients may end up waiting a long time for a new hip or knee.“
The growing need for joint replacement must be met not only with more surgeons, according to Kurtz, but also by increasing economic resources and longevity of the artificial joint. Among the reasons for the expected increased demand is that total joint replacement is gaining in acceptance. “There are few procedures that return as much quality of life as joint replacement,“ he explained.
Other reasons include an aging population with arthritis requiring joint replacement; the increasing prevalence of obesity, which puts undue stress on the knee and hip joints; and the trend toward baby boomers remaining physically active later in life, which also places demands on the joints.
Given these trends and the scientific methods that Kurtz' team used, their estimates are realistic, said Joshua Jacobs, MD, associate chairman and professor of orthopedic surgery at Rush University Medical Center (Chicago) and chair of the AAOS Council on Research, Quality Assessment and Technology, who was not affiliated with the study. However, future scientific advances could change their projections, he added.
If joint replacement surgeries increase as the authors projected, it will burden an already financially challenged healthcare system, according to Jacobs. “We're on a collision course between the demands placed by the Medicare population for services – joint replacement being a major one – and the ability of our society to pay for them,“ he explained.“
“There's always been this concern that with the baby boomer population aging, we were going to overwhelm the system that provides medical care,“ Mark Hutchinson, MD, professor of orthopedics and sports medicine at the University of Illinois Medical Center at Chicago (UIC) told the Chicago Tribune. “Our medical care is already costing more and more, and yet we're looking at a significant increase in the future.“
Hutchinson noted that artificial joint implants cost between $30,000 and $50,000, depending on where they are performed.
Costs of revision joint replacement is particularly great and must be reduced, Jacobs stressed. The best way is to make the original joint implant last longer. For that to happen, there is a need for more research to improve surgical materials and technologies, continuing education on best practices for surgeons performing the procedures and new medical approaches to prevent loosening of the implant. AAOS would like to see the federal government form a national joint-replacement registry similar to those in Sweden and other countries, he said.
No external funding was received for this study.