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The average person walks 10,000 steps every day. Each step, even at a leisurely pace, puts a force double your body weight on each leg, while running or descending stairs quadruples that force. The repetitive trauma caused to the knee and hip joints, coupled with the wear and tear from age, arthritis, and carrying excess weight often cause problems so severe for many people that the best solution is to replace the worn-out knee or hip with an artificial joint.
Steven M. Kurtz, PhD., director of the Philadelphia office of Exponent, Inc., an engineering and scientific consulting firm, and his research team estimate the number of knee replacements will increase by 673 percent and hip replacements by 174 percent in 2030, when the last of an estimated 76 million baby boomers are set to reach 65. Partial joint replacements are projected to increase by 54 percent and the repair or replacement of the artificial joint, called revision joint replacement is also expected to become more prevalent. The researchers based their numbers on historical procedure rates combined with population projections from the U.S. Census Bureau.
While there isn’t a shortage of artificial joints, there may not be enough qualified orthopedic surgeons to perform the implants. Orthopedic surgery is a specialized field requiring extensive training in the diagnosis and non-surgical as well as surgical treatment of the musculoskeletal system, including bones, joints, ligaments, tendons, muscles and nerves. Currently, an orthopedic surgeon performs approximately 52 surgeries annually, but by 2030 that number is expected to triple. With larger numbers of medical students and residents opting for the more lucrative spine and sports medicine instead of orthopedic surgery, many patients may be left waiting for several months or even a year for an implant. “There’s definitely going to be a huge need for more orthopedic surgeons,” said Kurtz. “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.”
Kurtz says that “there are few procedures that return as much quality of life as joint replacement,” which may be one of the reasons why it is gaining in acceptance. This growing need must be met with not only more surgeons, but also by increasing economic resources and longevity of the artificial joint, according to Kurtz. Joshua J. Jacobs, M.D., associate chairman and professor of orthopedic surgery at Rush University Medical Center in Chicago and chair of the American Academy of Orthopedic Surgeons (AAOS), says the estimates by Kurtz and team are realistic but adds that future scientific advances could change those projections.
According to Dr. Jacobs, if joint replacement surgeries increase as the study’s authors predict, we are “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.” Dr. Jacobs stresses that the costs of revision joint replacement are particularly great and must be reduced. For that to happen, we need more research to improve surgical materials and technologies, making the original joint last longer.
The AAOS has called for a national joint-replacement registry. Dr. Jacobs says that such a registry could help decrease the need for revision surgery, as it did in Sweden, by identifying best surgical practices and the best-performing implants in primary joint replacement.
Canada is already reporting a significant increase in the number of knee and hip replacement operations performed. However, many Canadians receiving implants are below the age of 55. A report published by the Canadian Institute for Health Information says that knee replacements have risen by 90 percent and hip replacements by 30 percent. Margaret Keresteci, the institute’s manager of clinical registries said, “The number of hip and knee replacement surgeries is increasing at a faster rate than the population is aging.”
The soaring numbers of younger patients receiving joint replacements point to an increasing obese population. The institutes’ report revealed that in 2004-2005, 9 out of 10 knee replacements were performed on patients who were either overweight or obese and nearly 8 out of 10 receiving hip replacements were on the heavier side. Ms. Keresteci concluded that “there is an association between obesity and the increased risk of osteoarthritis, which is the most common diagnosis in joint replacement surgery.”
The good news is that people who received these treatments in recent years experienced significant improvement in mobility and pain and were generally satisfied with the procedure. According to the report, the patients were spending less time in the hospitals than they were 10 years ago.
