Joint Replacement Soars as Number of Docs Falls

THURSDAY Feb. 26, 2009 -- More people are lining up for hip and knee replacements, just as the number of surgeons who do them is falling, two new studies reveal.

Both reports were presented Wednesday at the American Academy of Orthopaedic Surgeons annual meeting, in Las Vegas.

"In 2016, nearly 200,000 patients who require hip replacement and 750,000 patients who require knee replacement will not be able to have their surgery performed, because there will not be enough orthopedic surgeons available to do the procedure," said Dr. Thomas K. Fehring, lead researcher of the first study and an orthopedic surgeon with OrthoCarolina in Charlotte, N.C.

For the study, Fehring's team looked at the retirement age of doctors performing hip and knee replacements and the number of new doctors entering the field. Using this data, the researchers calculated the number of doctors who will be available to perform these procedures in 2016.

They found that by 2016, there will be significantly fewer doctors available to replace those who retire. By 2016, 46 percent of patients needing hip replacements will not get them, and 72 percent of those needing knee replacements will have to wait.

"I understood that there were not as many young surgeons going into the arthroplasty field as were retiring from the arthroplasty field, but it shocked me that, if the trends continue, nearly a million patients who need hip and knee replacements in 2016 will not have access to this life-changing procedure," Fehring said.

Low insurance reimbursements for these procedures appear to be keeping new doctors from choosing this specialty, Fehring said. Reimbursement for joint replacement has decreased 60 percent in inflation adjusted dollars since 1990.

"These economic realities are not lost on our residents in training when selecting a career," Fehring said. "Unless things change, this will lead to excessive waiting times for our senior citizens requiring joint replacement. Wait times of one to two years may ensue, which will be unacceptable to the general public," he said.

In the second study, Steven M. Kurtz, vice president of Exponent Inc., an engineering and scientific consulting firm based in Philadelphia, and his colleagues found the dramatic increase in the demand for joint replacements is largely driven by younger patients.

The researchers found that by 2011, more than 50 percent of patients needing hip replacement will be under 65, and that by 2016, more than half of those needing knee replacement will be also be under 65.

Many patients needing knee replacement are between 45 and 54. In 2006, 59,077 people in this age group had knee replacements, but by 2030, that number will increase 17 times to almost 1 million, Kurtz's team found.

This trend is driven by the success of these procedures as well as by people being more active and also obesity, which can trigger arthritis at an earlier age, Kurtz said. In addition, as the population ages, there will be a need for joint replacement in many more older people, he noted. "You either have a huge increase or a gigantic increase," he said.

Dr. Craig J. Della Valle, an associate professor of orthopedic surgery at Rush University Medical Center, in Chicago, said the findings of both studies are "worrisome."

"This mirrors what I am seeing in my own practice," Della Valle said. "The number of patients having these procedures is really increasing rapidly. It seems we are seeing more younger patients. Unfortunately, we are also seeing fewer surgeons who are choosing this as a specialty."

Dr. Hari Parvataneni, an assistant professor of orthopedic surgery at the University of Miami School of Medicine, said that the average joint replacement lasts 20 years, so as more younger people are having joint replacement surgery, the need for surgery to replace replacements will also grow.

"As the burden of joint replacements increase at a phenomenal rate, the burden of revision procedures increases," Parvataneni said. "Some of these revision procedures will require two to three times the cost of the primary implant, two to three times the clinical time of surgeons, but they only pay 20 percent more," he said. So, there are even fewer surgeons doing complex revisions, he said.

Parvataneni thinks that despite the low reimbursements issue, more surgeons should choose joint replacement. "It's hard to beat this specialty -- you change people's lives, and they are very happy for a long time," he said.

More information

For more on joint replacement, visit the U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases.

Posted: February 2009


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