Need for joint implants to
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
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,
"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
"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
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
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
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