Need for joint implants to jump

Long life, scientific advances, obesity responsible for increasing demand for knees, hips

As Americans live longer, exercise more and become increasingly obese, the number of artificial joints that will be needed to replace damaged knees will jump 673 percent by 2030 to 3.48 million a year, according to a new study.

The need for artificial hips will climb 174 percent over the same period to 572,000 a year, said Steven M. Kurtz of Exponent Inc., a Philadelphia-based engineering and scientific consulting firm.

The huge increase in artificial joints is the result of two converging trends - more people suffering wear and tear on their joints in a condition called osteoarthritis, and improvements in artificial joint technology that dramatically relieve pain and disability, experts say.

"A generation ago, when artificial joints were not available, individuals that had joint problems were crippled," said Dr. Joshua J. Jacobs, associate chairman of orthopedic surgery at Rush University Medical Center. "They couldn't participate in the work force and there was an enormous economic impact.

"Now that these artificial joints are available, people can be returned to the work force and returned to a higher quality of life," Jacobs, who was not involved in the study, said.

Nine out of 10 people receiving an artificial knee replacement report fast pain relief, improved mobility and better quality of life, according to a 2003 National Institutes of Health report.

"Five to 10 years ago, people who got into their 70s would think they were maybe too old for a joint replacement. Now you never hear that," said Dr. David Stulberg, an orthopedic surgeon at Northwestern University Feinberg School of Medicine. "People have become more comfortable that these things are going to last a long time, even when used for aggressive activities."

Joints normally suffer wear over time. The cartilage cushion between bones gradually erodes, causing pain when the bones rub together. This process is exacerbated by vigorous exercise or sports activities, which may injure joints, and putting on excess pounds, which places greater pressure on joints. Artificial replacements are made of metal and plastic.

The study projecting increased use of artificial joints also is seen as a harbinger of a looming health care crisis as medical technology eases the lives of more patients but greatly increases costs. As costs escalate they could add to pressures to deny underserved patients the benefits of this technology, medical experts say.

"There's always been this concern that with the baby boomer population aging that we were going to overwhelm the system that provides medical care," said Dr. Mark Hutchinson, professor of orthopedics and sports medicine at the University of Illinois Medical Center at Chicago. "Our medical care is already costing more and more and yet we're looking at a significant increase in the future."

Orthopedic surgeons already are the top users of hospital operating rooms, he said. At hospitals that care for a significant percentage of public aid patients, artificial joint implants are performed at a loss to the hospitals, he added.

"Ultimately, you'll risk bankrupting hospitals if they're expected to continue to give the same services at a continuing loss," Hutchinson said. Artificial joint implants cost between $30,000 and $50,000, depending on where they are performed.

"The good news is that there's not much in medicine that's as effective as a joint replacement procedure," Jacobs said. But on the other hand, "it does have a substantial public health impact in terms of what it costs society."

Jacobs and Hutchinson said they were worried that the projection of a big increase in implants may mean that there will not be enough orthopedic surgeons to meet the demand unless measures are undertaken to increase the number of medical school students majoring in orthopedics.

Another concern that has to be addressed, Jacobs said, is that at the end of 10 years, 10 percent of the artificial joints had to be replaced. The American Academy of Orthopedic Surgeons would like to see the federal government establish a national joint replacement registry similar to those in Sweden and other counties, he said.

The registry keeps track of all hospitals and surgeons who perform artificial joint implants and the types of joints they use, to monitor their success and failure rates. Hospitals that have higher failure rates are provided with educational information to improve their performance. If that fails, they are encouraged to stop performing joint implants.

( http://www.twincities.com/mld/twincities/living/14293199.htm )