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Speaker: Total joint replacement successful procedure despite implant failures
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The overall survivorship and patient satisfaction of total joint replacement is good despite implant failures and a changing patient population, according to a presenter at the 15th EFORT Congress – a combined programme in partnership with the BOA.
“Good satisfaction, good survival – what is the problem? The problem is not one of relative success, but the absolute issues that derive from having large numbers of people with small failure rates. In absolute terms that becomes quite expensive,” J. Mark Wilkinson, PhD, FRCS(Tr&Orth), said.
Wilkinson said in the European Union (EU), there has been an increased demand, as well as a changing patient population and epidemiology of total joint replacement. From 1990 to 2010, the incidence of hip osteoarthritis (OA) has increased 60% and more than 30 million people in the EU have OA. Currently, 25% of people aged 65 years or older have degenerative joint disease. In Eastern European countries, there also has been a shift in dominance of disability-adjusted life years from communicable diseases to degenerative diseases, with OA leading the increase.
As such, he said the demand for primary total hip replacement (THR) and the need for revision THR has increased in the EU. Currently, 765,000 patients have hip replacement surgery each year. He said 12% of implants fail within 10 years and each year 130,000 patients have revision joint replacement with estimated direct treatment cost of €3,000 million. He said that failure causes as much pain and disability as untreated arthritis.
Additionally, the indications have also broaden with older and younger patients now undergoing total joint replacement (TJR). Orthopaedic surgeons are also challenging implants with greater mechanical forces.
“Hip replacement, by in large in joint replacement, this is a successful procedure. [When] done well and with safe implants, survivorship and patient satisfaction is excellent and we should not lose sight of that message,” Wilkinson said.
He said changes in the epidemiology of TJR have increased the absolute cost of health care. Additionally, there have been changes in epidemiology in terms of infection and dislocation rate. Also, orthopaedic surgeons are seeing different adaptive and averse responses due to the different materials used in TJR, and “the biology of these is gradually being unraveled,” he said.
Reference:
Wilkinson JM. Why do implants fail? Presented at: 15th EFORT Congress: a combined programme in partnership with the BOA. 4-6 June, 2014; London.
Source info:
J. Mark Wilkinson, PhD, FRCS(Tr&Orth), is a professor of orthopaedic surgery, University of Sheffield, Sheffield, United Kingdom.
Disclosure:
Wilkinson has no relevant financial disclosures.