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What is the role of joint replacement surgery?

https://doi.org/10.1016/j.berh.2004.04.003Get rights and content

Abstract

Now into the fourth decade of widespread clinical acceptance and use, joint replacement surgery has had a major impact on the preservation of physical independence and general health in the ageing population. However, today's data are tomorrow's history. Rather than tell clinicians and patients what they might expect today from yesterday's procedure, this chapter surveys the role of joint replacement in the treatment of degenerative disease, assesses the associated fiscal burden on society and notes the significant gaps in our current knowledge. Strategies and approaches for future study are critically reviewed.

Section snippets

The burden of disease

Changes in both population demographics and age-related quality of life expectations present the modern physician with a major challenge in managing degenerative conditions of the musculoskeletal system. In Western society, advances in treating the leading medical causes of mortality have progressively pushed average life-expectancy into the eight and ninth decades. Data from the United States of America indicate that those over age 65 comprise the fastest growing segment of the population.1

Effectiveness evaluation of joint replacement surgery

With the increasing cost of health care, there is a growing demand that the costs of treatment be justified by proven measurement of quality of life improvement. In determining the appropriate utilisation for joint replacement surgery, and thus defining its role in the treatment of degenerative disorders, effectiveness evaluation is critical. Regional variations in the frequency of joint replacement procedures and the lack of consensus regarding many aspects of related patient care, have

The growing importance of national joint replacement registers

Quality improvement in all aspects of the process of joint replacement surgery, from materials and component design, to surgical technique, to patient care, requires organised, longitudinal data collection as outlined above. In recent years, spurred by the pioneering efforts of Sweden and Norway, there has been a growing interest in the formation of national joint replacement registers that systematically follow all patients who undergo a specific replacement procedure.17., 18., 19. While the

Factors contributing to the evolution of joint replacement surgery

As has been substantiated in several national registers in recent years, the incidence of joint replacement procedures has increased at a faster rate than can be ascribed solely to the effects of population increase and population ageing.18., 19., 20., 21., 22. Projection data from the USA estimates that the number of total knee replacements in the female population will reach 274 000 procedures per year in 2030 versus roughly 155 000 per year today.1 The projections for total hip replacement

Effectiveness of joint replacement surgery

With this background of relevant issues, the following sections will discuss our current understanding of the effectiveness of joint replacement surgery in treating a variety of arthritic conditions.

Indications and contraindications

One way to tackle questions regarding the role of a treatment modality is to define conditions for which it should not be used in absolute and relative terms. The main absolute contraindication to any joint replacement surgery is active infection. This includes not only localised septic arthritis and osteomyelitis but also regional and systemic infection elsewhere in the body. Tooth abscesses, urinary tract infections and sinusitis, although remote from the affected joint, may haematogenously

Revision joint replacement

A detailed discussion of revision joint replacement is beyond the scope of this chapter but the following brief review highlights how the likelihood of revision surgery influences the primary process. While the quality and reliability of joint replacement surgery has advanced markedly over the past three decades, experience continues to demonstrate the finite lifespan of prosthetic components. Survivorship rates vary extensively depending on the factors mentioned above. It is impossible to

Summary

Joint replacement surgery represents one of the most significant advancements in the history of orthopaedic surgery and is widely accepted as an effective treatment for end-stage arthritis. The role of joint replacement surgery should be defined in terms of critical outcomes analysis. When the myriad of contributing factors is considered, it becomes apparent that the quantitative measurement of health-related quality of life improvement after joint replacement surgery cannot be divorced from

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