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The demand for TJR will continue to escalate

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The number of orthopaedic surgical procedures performed each year has increased significantly throughout the past three to four decades, placing a burden not only on the hospitals but also the national health budgets, and certainly on the surgeons who perform them. As a consequence of this increase, waiting for orthopaedic surgery has become a dilemma for patients, who almost always want the procedure to be done as soon as possible.

Total joint replacements (TJRs), specifically total hip arthroplasty (THA) and total knee arthroplasty (TKA), evolved in Western countries in the 1960s and 1970s. Since both procedures have increased in popularity during that time, health care officials and surgeons have had to determine why this is taking place and how it will influence the joint replacement burden in the future.

Keeping up with the old, young

Among several possible reasons for the increase in THA and TKA procedures, the most visible seem to be the aging population’s demand for an active lifestyle, and the fact that people live longer today and are in better general health than those who came before us. Likewise, the surgeries have become more reliable and, thus, our outcomes have continued to improve.

It is also worth mentioning that the younger generation is extremely well-educated in the possible treatment modalities, thanks to information gleaned from Web sites, news reports and talking to patients who underwent the procedure. When young patients enter our outpatient clinics, they have made up their mind that joint replacement procedures are routine operations, and they request and expect to maintain their current active lifestyle postoperatively.

In addition, the average orthopaedic surgeon is more confident than ever with the indications for THR and TKR as well as the surgical procedures themselves, so refusing to perform the procedures on patients due to their age becomes less acceptable. As a consequence, the total number of cases has increased – and will continue to increase for years.

More knees than hips

In almost all Western countries, TKA is increasing at a greater pace than THA. This is difficult to explain. The only item that has really changed in most national registers, besides the overall increase in total number of TKA procedures performed, is the fact that more unicompartmental knees are performed today compared to years ago. Another reason could be the fact that the infrastructure and access to TKA services has improved, allowing surgeons today to treat the actual need better.

In Eastern Europe, major joint replacement started in the early 1990s with the breakdown of the Iron Curtain. Initially, implants were available only for a small number of patients and surgeons. Procedures were far from the standards we had in Western Europe, but today, most Eastern European countries are quickly approaching the levels seen throughout the rest of Europe.

Therefore, TJR will continue to be a central topic for all European orthopaedic societies, with a focus on increasing the numbers of not only primary replacements but also accommodating the increasing revision burden.

It will also require us to train more surgeons to do the operations, and focus on the logistical changes required in our clinics and the overall health care structure to facilitate quicker rehabilitation – all while keeping complication rates low and patient satisfaction high. This will require hospitals that perform a high number of joint replacements to incorporate fast-track rehabilitation programs.

For more information:

• Per Kjaersgaard-Andersen, MD, is an assistant professor of orthopaedic surgery, Vejle Hospital at South Danish University, Vejle, Denmark, and is the president of the Danish Orthopaedic Association. He is also the chief medical editor of Orthopaedics Today Europe. He can be reached at ote@slackinc.com.

Reference:

• Rapp SM. Fast-track rehab program has accelerated and improved post-joint replacement care. Orthopaedics Today Europe. 2009;12(4):6.