In the near future, there may not be enough orthopaedic surgeons to provide joint replacements to all who need them. According to two new studies presented at the 2009 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS), the number of patients requiring hip or knee replacement surgery is likely to soon outpace the number of surgeons who can perform the procedure.
According to a study co-authored by Thomas K. Fehring, M.D., if the number of orthopaedic surgeons able to perform total joint replacements continues at its current rate: - In 2016, 46 percent of needed hip replacements and 72 percent of needed knee replacements will not be able to be completed.
"I was somewhat shocked at the shortfall that we predicted," says Dr. Fehring, an orthopaedic surgeon at OrthoCarolina Hip and Knee Center in Charlotte. "This is life-changing surgery, offering patients the chance to be mobile, and a very high percentage of patients may not be able to receive it."
Joint replacement, also known as arthroplasty, is considered by many to be one of the most successful medical innovations of the 20th century. Total joint replacement is a surgical procedure in which the patient's natural joint is replaced with an artificial one. - More than 700,000 primary total hip and knee replacements are performed each year in the United States, and demand for the surgery is expected to double in the next 10 years.
A second study co-authored by Steven M. Kurtz, Ph.D., found that a major reason for the growth in patient demand for joint replacement is the increase in younger patients. - Projections show that by 2011, more than 50 percent of patients requiring hip replacements will be under the age of 65; the knee-replacement patient population will reach that threshold by 2016. - For primary total knee replacement, the fastest growing group of patients is in the 45-54 age category; the number of procedures performed in this age group is projected to grow from 59,077 in 2006 to 994,104 (an increase of 17 times) by 2030.
"Joint replacement is generally thought of as a procedure for older people, over 65," says Dr. Kurtz, corporate vice president and office director at Exponent, Inc., in Philadelphia. "Our projections show that younger people make up a big piece of the pie, and that is only going to increase if historical trends continue."
Both researchers believe that the key to stemming this supply-side crisis is for policymakers to reconsider the rates at which total joint replacements are reimbursed. The reimbursement rates have consistently gone down over the years, even as the costs of providing health care have gone up.
However, Dr. Kurtz notes that the possibility of new technologies may offer a glimmer of hope. "It's hard to predict what changes will come about in the next 20 years," he says. "Hopefully, we will have some new tools in the future to help address this problem, which could be of epidemic proportions."