Better, faster, stronger

The numbers don't lie. Two years ago, the U.S. hip and knee replacement market was valued at $6.7 billion.

By 2015, according to analysis firm GlobalData, the market is forecast to reach $14.8 billion. Shoulder replacements, though not nearly as common as knee and hip replacements, are also on the rise.

Locally, joint replacement surgeries seem to be following this national trend.

Dr. David Boardman, an orthopedic surgeon with Kaiser Permanente NW, said he had 400 knee replacement cases in 2006. In 2010, that number has climbed to 1,000. He also said that a few years ago, there was approximately a one-to-one ratio of knee to hip replacements. Currently, that ratio has increased to more than two-to-one.

Boardman said three demographic factors are driving this trend:

  • An aging population – all baby boomers will be 55 or older by 2020
  • Culturally, people are less tolerant of pain and want to be more active
  • People are getting heavier

A Weighty Problem

A 2007 Clark County Public Health release titled "Prevalence of Obesity and Overweight" revealed that roughly 46 percent of Clark County adults were overweight or obese in 1996; that figure rose to 62 percent by 2005. According to the same document, from 1996 to 2005, the obesity rate in Clark County rose from 16 to 25 percent.

"There is a causal relationship between obesity and knee arthritis," said Boardman.

Not Just for Senior Citizens

Tim Bock, nurse manager for Legacy Salmon Creek Medical Center's Total Joint Program, added perspective to the joint replacement demographic of age. He said that the Pacific Northwest was characterized by very active, motivated patients who didn't just want to resolve pain, but desired to return to prior activity levels such as hiking, biking and golfing.

"There's a sense of wanting to preserve a higher functional lifestyle," said Bock.

Bock said roughly 30 to 35 percent of Legacy's joint replacement patients are under the age of 60, and that number is growing. In fact, two of Bock's nursing staff members have had hip or knee replacements, and both are under age 60.

Technological Advances

Experts in the orthopedics industry, such as Dr. Todd Borus, an orthopedic surgeon with Rebound Orthopedics and Neurosurgery, say that not only are candidates for joint replacement getting younger, but new technology is helping to make surgery easier.

"We are more comfortable offering joint replacement to younger patients because materials are improved," said Borus.

Borus said significant improvements in surgical techniques make procedures less invasive and more preserving to native bone and tissue. These techniques, combined with more aggressive physical therapy, provide several benefits including reduced pain, earlier recovery and a more natural feel to the replacement joint.

One example of technological innovation in joint replacement is Legacy's new RIO® Robotic Arm Interactive Orthopedic System, a robotic partial knee replacement system that enables surgeons to selectively replace only the damaged aspects of the knee, with programmed precision.

Legacy added the RIO system to their Total Joint Program in December 2009. Borus, who performs his Rebound surgeries at Legacy, has already done 86 surgeries using the system – the only one of its kind in the Pacific Northwest.

"Some orthopedic technologies don't deliver on their promise," said Borus. "But this technology has been amazing."

Borus said the manufacturer of the RIO system will be launching a partial-hip replace-ment program, similar to the knee program, in the near future.

In addition to the new
technology, Legacy Admin-istrative Officer Jonathan Avery said the medical center hopes investments in nursing, clinical staff education and a dedicated unit on a new floor will allow them to keep up with patient demand.

Marketing Strategies        

Another reason joint replacement surgery is on the rise, according to Kaiser's Dr. Boardman:  more informed patients. Historically, implant manufacturers marketed to surgeons. Today, they're marketing directly to patients.

"I'm not a proponent of this, but it's hard for a surgeon to say no if a patient wants something," said Boardman. "It's like saying, ‘I don't want your business.'"

However, newer doesn't always mean better, cautioned Boardman. He said Kaiser's National Joint Registry, which tracks more than 100,000 joint replacement patients, helps the hospital's surgeons decide which new technologies actually live up to their marketing hype.

"The orthopedic industry tends to follow technology before the clinical evidence is there. Our registry helps us decide which new implants and surgical techniques to choose," said Boardman.

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