Surgeons Unable to Meet Demand for Joint Replacement in the US

American Academy of Orthopaedic Surgeons annual meeting, in Las Vegas threw up some startling relevations regarding Joint Replacements .According to a report published in the meet, 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 of the shortages of orthopedic surgeons available to do the procedure," according to Dr. Thomas K. Fehring, lead researcher of the first study and an orthopedic surgeon with OrthoCarolina in Charlotte, N.C.

While Hip Replacement and Knee Replacement in the US is something that is commonplace and done quite frequently, some healthcare experts say that this might change very soon due to the mismatch between demand and supply

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

the study shows 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," said Dr. Thomas K. Fehring, lead researcher of the first study and an orthopedic surgeon with OrthoCarolina in Charlotte, N.C.

One of the reasons for lesser orthopedic doctors from joining this specialty appears to be low insurance reimbursements.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.

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.

According to the study,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, In addition, as the population ages, there will be a need for joint replacement in many more older people, according to the study.

Click here to know more about this study

Frequently Asked Questions on Knee Replacement

Knee Replacement surgery is bascially of two types 1)Total Knee Replacements which involves the entire replacement of the knee as opposed to only partial replacement.Traditionally these kind knee replacement involves a 7-8” incision over the knee by the surgeon and includes staying at the hospital for 4-5 days .

Partial Knee Replacement or Unicondylar Knee uses smaller implants and dues not involve making a deep incision and uses minimally invasive techniques.In partial knee replacement, the damage to the knee is limited to one part of the knee joint. The severely damaged part of the knee joint is hence replaced.

This surgery has advantage over total knee replacement. It's done through minimum invasion hence the damage to the tissue cells is far less. The patient returns to his normal lifestyle faster.

How common is knee replacement surgery?

Knee replacement is a routine surgery performed on over 600,000 people worldwide each year. Over 90% of people who have had Total Knee Replacement experience an improvement in knee pain and function.

How old is the average patient?

In the U.S., the average joint replacement patient is around 65-70 years old, however patients of all ages have received knee implants.What is unicondylar arthroplaty, or partial knee replacement?

Partial knee replaces only the area of the knee that is worn out, sparing patients the more medically complicated and involved total knee replacement surgery.


What are the advantages unicondylar arthroplasty?

With a partial knee replacement, there is a dramatically shorter recovery time due to less surgical trauma, less scarring and fuller range of motion.


How is it different from total knee replacement?

During total knee replacement, surgeons typically make a 7 to 8-inch incision over the knee, patients stay in the hospital for approximately four days, and there is a recovery period of up to three months. During minimally-invasive partial knee surgery, a part of the knee to be replaced through a small, 3-inch incision. There is minimal damage to the muscles and tendons around the knee and the required hospital stay is up to two days. The recovery period is about one month.

You mentioned recovery is faster. What does that mean?

Patients often walk unassisted within a week or two of the operation. Even those who have both knees done at once are able to walk without the assistance of a walker or cane fairly quickly.

What does the surgeon do during a unicondylar arthroplasty?

When a knee replacement is performed, some bone and cartage are removed using precise instruments to create exact surfaces to accommodate a metal and plastic prostheses.

How long will knee replacement surgery last?

Knee replacement surgery has been documented to last beyond fifteen years for many patients. The overall failure rate is less than 1% per year.

How do I know if I am a candidate for this surgery?

Candidates for this surgery are generally younger, more active patients. The partial knee replacement allows for symptoms of pain or discomfort. The procedure allows younger patients to buy time before they need a full knee replacement. The procedure is also effective for older patients if they have disease localized to one half of the joint.

After surgery, is it normal for my knee to look larger than my other knee which has not had knee replacement surgery?

It is common for a post-operative total knee to be larger than the natural, native knee. That is a very common feature and finding and is not necessarily related to the parts being a different size than the amount of bone that was resurrected.

Is it normal to have numbness along the outer or lateral aspect of the incision?

It is common to develop some numbness or change in sensation over the lateral or outer aspect of the incision after surgery. The normal skin nerves run from the inner aspect of the knee, rotating to the outer aspect of the knee. Incisions that are made directly over the front of the knee oriented along the length of the leg will cut across these nerves. Generally, after four to 6 months, much of the skin sensation will return. However, in some patients, there is always a reduced degree of sensation over the outer aspect of the knee. Usually, this is of little clinical significance.

How soon can I return to normal activities after surgery?

Within six weeks after surgery, most patients are able to walk with a cane. You will probably feel well enough to drive a car within seven to eight weeks after surgery.

In most cases, successful joint replacement surgery will relieve your pain and stiffness, and allow you to resume many of your normal daily activities. But even after you have fully recovered from your surgery, you will still have some restrictions. Normal daily activities do not include contact sports or activities that put excessive strain on your joints. Although your artificial joint can be replaced, a second implant is seldom as effective as the first.

Will an implant set off a metal detector?

Since knee implants are made of metal, there’s a chance they could set off metal detectors. Patients have reported mixed experiences at airports: some detectors go off and some don’t.You may be provided with a special card to keep in your wallet explaining that you have a knee implant.

For more information of Knee Replacements proceures and FAQs check out these following websites.

Wockhardt Hospital,Bone and Joint Care
Georgetown university Hospital
Knee Replacement Guide

Orthopedic Problems in Women and their Treatement

We have with us today Dr. Sachin Bhonsle,Consultant Joint Replacement and Orthopaedic Surgeon at Wockhardt Bone and Joint Care, Mumbai, India who talks about Orthopedic problems in Women.

Dr.Bhonsle was a Lecturer in Orthopaedics in the premier and highly acclaimed institute Seth GS Medical College and KEM Hospital, Mumbai University. He was also the HOD (head of department) at the Department of Orthopaedics in Derna, Libya,before he Joined Wockhardt Hospitals

Here are some of the excerpts of his Interview with us

Are orthopedic problems dependent upon Gender

While orthodpedic problems does not make a distinction between men and women, Some research suggests that women might be prone to more bone and joint related disorder than men.Biomechanical, genetic and lifestyle differences between the genders contribute to the disparities in men’s and women’s pain. In certain cases, treatments may need to take gender-specific issues into account to deliver effective pain relief.

Medical Research suggests the following:

• Women are three times more likely than men to suffer from Carpal Tunnel Syndrome
• Women are twice as likely as men to suffer from Runner’s Knee (Chondromalacia Patella, or Kneecap Pain)…

• 41% more women than men (41 million vs. 29 million) suffer from Arthritis in general.

• Women are more likely to have Osteoarthritis of the Knee and thumbs

• women are more likely to get rheumatoid arthritis
• Women are more susceptible to footwear-induced ankle sprains than men
• Women tend to suffer more often from fibromyalgia
• Women develop osteoporosis more often as well as earlier than men

Biologically, there are several situations for women (unlike men) that demand additional care to manage today’s fast paced multi-tasking lifestyle.

What are some of the most common Bone and Joint Problems in Women

Carpal Tunnel Syndrome

is the name for a group of problems including numbness, pain, tingling, especially in early mornings and weakness in the hand. It is often the result of swelling inside the carpal tunnel, which places pressure on the median nerve

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WHY WOMEN: Research suggests that because women’s wrists are on average, 10 % narrower due to which women can be more susceptible to crowding in the carpal tunnel passage. Hormonal changes during pregnancy and menopause can also contribute to Carpal Tunnel Syndrome and are exclusive to women. Women also suffer more often from thyroid problems which are directly linked to Carpal tunnel syndrome.

TREATMENT: wearing a wrist brace, especially at night, as one part of therapy. Treatment may also include medications, stretching and strengthening specific wrist muscles and changing the position of the wrist while in use. If symptoms persist, a physician may recommend injection or surgery. Surgery of carpal tunnel is a very simple and successful surgery which instantly and permanently cures the symptoms

Arthritis:

Arthritis means an inflammation of a joint eventually leading to wear and tear which results in painful and deformed joint. 60 % of people who have arthritis are females, and several of the more common forms are more prevalent in women. Apart from pain, stiffness in joints, redness around the joint, swelling and difficulty in performing the day to day activities are the most common symptoms.

WHY WOMEN ARE MORE SUSCEPTIBLE THAN MEN : For reasons unknown, women are most likely to get arthritis. The most common type is Osteoarthritis which is really wear and tear and essentially not a disease, mostly affecting women over 40 years. Rheumatoid Arthritis: 70 % of people with this type of arthritis are women, according to the Arthritis Foundation. It is inflammation of the synovium (lining) of the joints and can result in painful damage to the joints, affecting in the age group of 30 onwards.

TREATMENT: Early diagnosis of arthritis sets the stage for a proper treatment plan.The treatment plan may include a comprehensive diet and exercise program with best medications to lessen pain, increase movement and reduce fatigue. Role of physiotherapist is to work out correct exercise regime. Occupational therapist can help with activities of daily living. Surgery is sometimes required to reconstruct or replace a joint. Reconstruction of the joint can often be done by key hole surgery (arthroscopy). Joint replacement is a valuable tool in improving quality of life.

TREATMENT: Stretching and strengthening quadriceps and hip muscles can be helpful. Runners should run on softer surfaces, and use correct running shoes. Rest, Ice packing, splintage, patellar taping are useful. Surgical treatment is sometimes sought and it can be helped with arthroscopy.

Chondromalacia or Patella or Runners Knee:

This is characterized by pain is infront of the knee, especially while running, walking or ascending/descending stairs. This condition is caused by softening of patellar cartilage as well as mechanical alignment abnormality of patella.

WHY WOMEN: A woman’s pelvis is, on average, developmentally broader than a man’s pelvis to assist childbirth.As a result, women tend to be more “knock kneed” than men. Women may have hip weakness and excessive pronation, which may also contribute to biomechanical misalignment. These differences can put additional pressure on the patella, or kneecap, which can cause pain as the kneecap tracks up and down in its natural groove (patellofemoral groove).

WHY WOMEN: A woman’s pelvis is, on average, developmentally broader than a man’s pelvis to assist childbirth.As a result, women tend to be more “knock kneed” than men. Women may have hip weakness and excessive pronation, which may also contribute to biomechanical misalignment. These differences can put additional pressure on the patella, or kneecap, which can cause pain as the kneecap tracks up and down in its natural groove (patellofemoral groove).

Ankle Sprains: Certain types of footwear ladies favour tend to risk ankle and foot injuries.

WHY WOMEN: The higher the heel of a shoe, the more likely the ankle is to be unstable. In addition, women have a narrower heel in relation to the forefoot, and narrower feet overall. Also hormonal changes around menopause predispose relaxation of ligaments in feet.

TREATMENT: A program of strengthening and balance exercises may aid in recovery. Wearing an ankle support can reduce swelling and support the ankle ligaments.

Fibromyalgia: A condition with muscular pain through the body, specific tender points and fatigue. Often symptoms are vague. They tend to respond to certain medications lyke pregabalin and physiotherapy.

Osteoporosis: Losing calcium from the bones results in osteoporosis. Consequently the bones become weak and much more prone to fractures. Osteoporosis is best prevented rather than treated. Ladies need to act early in their life for this. There is a similar disorder called osteomalacia which is related to Vitamin.

WHY WOMEN : Menopause in late 40s or early 50s reduces the oestrogen in the body which is essential to keep the calcium in the bones. As a result after menopause there is accelerated weakening of bones.

TREATMENT : Preventive treatment includes weight bearing exercise like walking, jogging. Healthy lifestyle is important. Calcium and Vitamin D supplements are necessary for most ladies over 40. Once osteoporosis is established it can be treated with several medications but the bone strength may never return to normal. Fractures are managed best by orthopaedic surgeons once they happen.

To Know about Bone and Joint Treatements and to schedule an Consultation with Wockhardt Hospitals,Bone and Joint care,Write into enquiries@wockhardthospitals.net

courtesy

Dr. Sachin Bhonsle
Consultant Joint Replacement and Orthopaedic Surgeon
Wockhardt Bone and Joint Hospital, Mumbai, India
Qualification
MS (Orthopaedics) , FRCS (Glasgow, UK)