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A New Problem for the Baby Boomer Generation

Posted on: 04/23/2009
Here's a problem the Baby Boomers probably never thought they would face: not enough surgeons available to perform all the hip and knee replacements that are needed now. And it's not just the aging Baby Boomers who are affected. More and more younger patients (younger than 65) find themselves in the same boat. Experts say the problem is going to get worse before it gets better.

Right now, almost three-fourths of a million adults in the United States get a new hip or knee every year. That number is expected to top one million very quickly. It is predicted that by the year 2016, half of all patients who need a hip replacement won't be able to get one. And three-fourths of all patients seeking a knee replacement will be on a waiting list for a very long time.

There are two groups who are going to be affected the most by this problem: adults in the 45 to 54-year age group and adults older than 80 years. In both cases, increased activity and desire for improved quality of life are the reasons behind the increased demand. Emotional health, social function, and physical comfort are all affected by the pain of an arthritic joint.

Advanced technology and improved surgical technique has made joint replacement easier and safer than ever before. There are fewer risks and complications. This is especially true in the older population -- another reason why joint replacements are becoming so popular. What's the answer to this supply and demand dilemma? Some experts suggest that avoiding this problem is possible.

They say that policy makers need to increase the rate of reimbursement to surgeons for total joint procedures. Medicare keeps reducing how much they will pay while the costs of doing business in the health care world continue to rise. Another possible solution is to prioritize patients according to need and predicted outcome. What does that mean?

Well, we know, for example, that patients who have worse function before surgery tend to have poorer outcomes after surgery. Women and certain ethnic groups (e.g., Hispanic, African American) fall into this category. It may be a coincidence that these patients have worse function before seeking out a joint replacement. Or it may be that people in these groups delay treatment for too long. Lack of insurance, cultural issues, or less access to care may also be reasons for this delay. Getting them in for surgery sooner than later may actually improve their results.

All of this points to the need for education. First, for the policy makers responsible for determining reimbursement rates on surgical procedures. Then to aging adults who are starting to develop joint problems. With modified activity, strengthening exercises, and medications, the effects of osteoarthritis can be prevented and managed much longer. It may be possible to reduce the need for joint replacements (or at least delay surgery it without affecting the final results).

Who is going to do this education? Orthopedic surgeons may head the campaign. But the efforts of all health care providers will be important in this area. This includes physical therapists, physician's assistants, nurse practitioners, and chiropractors. Fitness instructors and personal trainers can also receive instruction in this area that can be passed along to their active clients whose activity level may put them at risk some day for disabling arthritis that requires joint replacement.

The Ins and Outs of Joint Replacement. In The Journal of Musculoskeletal Medicine. April 2009. Vol. 26. No. 4. Pp. 124-126.

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