In a recent article published in the Journal of Bone and Joint Surgery, July 2008, authors Richard Iorio, et al, outlined the growing concern regarding the future burden of joint replacement surgeries. They looked at data from the United States Census Bureau, which predicted an 18% growth in the United States population between 2000 and 2020. During that interval, there will be a 37% increase in the number of people age 45 and older. By the year 2020, it is estimated that 59.4 million (18.2%) of Americans will be affected by arthritis. Several factors are contributing to the increase in arthritis including, the prevalence of obesity, as indicated by a body mass index greater than or equal to 30. The number of Americans between in 1990 that fit that definition was 22.9%. This increased to 30.5% by the year 2000. Patients who are of normal weight have a risk of arthritis of approximately 16.3%, while the obese individual has a risk of 31.6% for the development of osteoarthritis. Associated with the increasing prevalence of osteoarthritis there is a decreasing number of orthopedic surgeons who specialize in joint replacement surgery. Currently there are 120 Fellowship positions for post graduate training in joint replacement surgery in the United States and only 74 (62%) of these positions were filled. Furthermore, 20% of those filled were by international medical graduates.
Reimbursement has also influenced the number of people specializing in joint replacement surgery. During the period from 1991 to 2007, Medicare payment to hospitals for joint replacement surgery increased by 24% while during that same period the reimbursement to physicians declined by 39%. The cost of living increased 49% during that same period.
Orthopedic surgeons who specialize in joint replacement surgery typically do nine hip replacement and nine knee replacements per month, while generalists perform roughly three hip and knee replacements per month. The percentage of all surgeons performing joint replacement who perform revision procedures is only 43%, thus making revision of complex cases harder to be handled by a shrinking number of specialists in joint replacement surgery.
The article concluded that there is a significant volume of joint replacement surgery that will need to be taken over the next 15 years. As hospital profit margins shrink and payments to physicians for joint replacements fall, the number of facilities and surgeons continuing to do the surgery may in fact decrease. This may lead to longer wait times for surgery, approaching the one to two year wait time that can occur in Canada and England. It is important that this information is disseminated to educate patients, patient advocacy groups, health care providers, and health care policy makers to help change the work force problems that may face adult joint replacement surgery in the future.
