After reviewing thousands of case studies going back 25 years across six countries, generalisable survival data is now available for the first time to estimate how long hip and knee replacements are likely to last.
The findings of researchers, funded by the National Joint Registry, from the Musculoskeletal Research Unit at the University of Bristol have been published in The Lancet. These findings show that eight out of ten total knee replacements and six out of ten total hip replacements will still be in place after 25 years.
“Over two million hip and knee replacements have been performed in the UK since 2003 and patients often ask clinicians how long their hip or knee replacement will last, but until now, we have not had a generalisable answer.” said lead author Dr. Jonathan Evans, National Joint Registry Research Fellow and Clinical Research Fellow at the Bristol Medical School; Translational Health Sciences (THS), based at Southmead Hospital.
Danette Lake thought surgery would relieve the pain in her knees.
The arthritis pain began as a dull ache in her early 40s, brought on largely by the pressure of unwanted weight. Lake managed to lose 200 pounds through dieting and exercise, but the pain in her knees persisted.
A sexual assault two years ago left Lake with physical and psychological trauma. She damaged her knees while fighting off her attacker, who had broken into her home. Although she managed to escape, her knees never recovered. At times, the sharp pain drove her to the emergency room. Lake’s job, which involved loading luggage onto airplanes, often left her in misery.
When a doctor said that knee replacement would reduce her arthritis pain by 75 percent, Lake was overjoyed.
For people considering hip or knee replacement surgery, it’s something they want — and need — to know.
In the US alone, surgeons perform more than 600,000 knee replacements and about 330,000 hip replacements each year. These operations can provide a major improvement in quality of life and function for those with severe arthritis. On the other hand, there are risks associated with the operation (as is true for any major surgery), there is a long road to recovery even when all goes well, and these operations aren’t cheap. For knee replacement surgery alone, an estimated $9 billion or more is spent each year in the US (although economic analyses suggest the surgery may actually be cost-saving over the long run).
So, if the first joint replacement is unsuccessful for some reason (such as infection or loosening), a second (or even third) operation may be necessary. And that’s a big deal, especially since “revision surgery” is technically more difficult, recovery can take longer, and success rates may be lower than first operations.
When the US Women’s National Soccer Team clinched the World Cup this summer, forward Amy Rodriguez celebrated an additional victory—her successful (and physical therapy-aided) return to the team after having a baby not quite 2 years earlier.
Rodriguez shares her story on the most recent episode of Move Forward Radio—how she approached her pregnancy and return to sport, and the role that physical therapy played in that journey. Although told through the eyes of a world-class athlete, Rodriguez’s story will resonate with moms of any athletic ability who want to regain a physically active lifestyle after childbirth.
Other recent Move Forward Radio episodes include:
Total Knee Replacement: A Storybook Approach Louise Chegwidden, PT, FT, has watched patients and families struggle to cope with the information overload that accompanies total knee replacement surgery, and decided there had to be a better way to prepare families and improve expectations. To fill that void, she wrote a guidebook for families called “Granny Gets a New Knee: and a Whole Lot More.” Chegwidden discusses some of the things patients and family caregivers should know about total replacement surgery, including the benefits of seeing a physical therapist before the procedure. (You can read more about Chegwidden and other physical therapist book authors in PT in Motion’s July feature story “Physical Therapist Authors.”)
Hip and knee replacement surgery—which is nearly always partnered with rehabilitation including physical therapy—is the target of a proposed Medicare test of a bundled payment model, which will hold acute-care hospitals in 75 areas around the US accountable for their costs and quality of care. It’s yet another signal that health care reform is moving away from fee-for-service payment models and toward paying for value and outcomes.
The chosen areas include Los Angeles and New York City as well as smaller markets, and would affect more than 800 acute-care hospitals. Unlike similar tests of the past, there’s no voluntary sign-up; all facilities must participate.
The 5-year test period would begin January 1, 2016, and end December 31, 2020. Participating hospitals would bear the financial risk of the episode of care, which would begin at admission to the hospital and end 90 days after discharge, to include all related care covered under Medicare Parts A and B—the procedure, inpatient stay, hospital care, postacute care, and provider services.
What do the costs of hip and knee surgery have in common with real estate prices? Apparently, it’s all about location, location, location.
According to a new report issued by the Blue Cross Blue Shield (BCBS) Association, differences in the prices of these surgeries can vary by as much as 313%–within the same metropolitan area.
BCBS looked at claims for the surgeries over 3 years in 64 markets and found dramatic variations in costs, from a low of $11,317 in Birmingham, Alabama, to a high of $69,654 in New York City for total knee replacement, and from $11,327—again in Birmingham—to $73,987 in Boston, Massachusetts, for hip replacement surgery.