In the past the goal of the medical profession was to find magical cures for diseases. In the 21st century the objective of medical science is to find methods of preventing diseases. The elimination of polio in the US is one example of a successful prevention campaign. A partially successful campaign has led to a decrease in smoking, while an example of a campaign that so far has failed is the fight against obesity. Today a cure for lung cancer by surgery, radiation and chemotherapy is considered not so much a success of modern medicine as a failure of prevention. This Web site poses the question of whether a Total Knee Replacement is a successful, albeit, temporary, cure, or rather the result of failed prevention. While the public health benefits of successful prevention are obvious, there also are very strong financial reasons for avoiding the more common—and expensive—late-stage cures. In a March 2006 interview, Dr. Elias Zerhouni, director of the National Institutes of Health, pointed out that the practice of medicine in the United States today is financially unsustainable. If bankruptcy of the medical care system is to be avoided, the high cost of treating so many diseases in their late stages must be radically reversed. Dr. Zerhouni went on to stress the urgency of finding ways to prevent these expensive diseases from occurring in the first place or, if already under way, to intervene as soon as possible in the early stages. Since his interview was published in an orthopedic journal, ref he would have been considering Total Knee Replacements as the treatment for the late stage of the various types of arthritis of the knee. In 2007 alone, an estimated 600,000 knee replacements will have been performed in the US, the majority as treatment for osteoarthritis. A recent government study projected that, at the current rate, by the year 2030 some 2.6 million knee replacements will be performed just in the US. The following 3 graphs represent the numbers of Total Knee Replacements, Total Knee Replacement Revisions and Average Hospitalization Costs for Knee Replacements. They are based on numbers compiled by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services. The numbers were put in graph form and made available by The American Academy of Orthopedic Surgeons.
The graph above shows that approximately 10 percent of patients who received a Total Knee Replacement required a second operation.
Projecting the rate in increase in hospital costs from the three-year period 2000 to 2003 into 2006 results in hospital costs for a knee replacement being $38,000 and, for a revision surgery, $56,000. Extrapolating the number of operations and their cost into an estimated 2.6 million operations in the year 2030, it is clear that the cost soon will be unsustainable. By contrast, the cost of prevention or early intervention is considerably less. Bow Legs and Knock Knees Although accurate data on the cost of prevention of OA due to bow legs or knock knees is difficult to calculate, they can be estimated due to the simplicity of the procedures. A rough indication of benefits from realignment procedures for bow legs and knock knees can be categorized according to AGE:
Toddlers between 1-5 years of age can be treated conservatively, with the expectation that their legs will straighten out by the time they are 5 years old. The legs of children between 6-14 years old can be straightened out by slowing growth on one side of the knee with temporary staples. This is a quick outpatient procedure, and a cure can be expected. From age 15-30, a leg bone must be broken in order to set the knee straight. While it is a more complicated operation than putting in a staple, it still can often be performed as an outpatient procedure. The prognosis remains good, but it would have been preferable to treat the condition earlier. The treatment for a patient aged 31-60 is intermediate intervention. While similar to the treatment of the previous age group, at this later age there typically has been more damage to the knee surface. Patients aged 61-75 may have experienced so much damage to the joint surface on one side of the knee that a replacement of that compartment may be necessary. While this procedure removes only the third of the knee that is arthritic, it is technically difficult, and is usually best undertaken by surgeons who perform the procedure frequently. After age 75 it can be expected that most patients will have reached the stage when the best chance for improved quality of life will result from a Total Knee Replacement. Chemical-Based (Rheumatoid) Arthritis Currently the prevention of chemical-based arthritis does not appear imminent. There have been improvements in early diagnosis and medical intervention, however. Ultimately one can expect a marked decrease in the need for Total Knee Replacement in this group of patients as well. Sports-Related Injuries It is difficult to predict what the future holds for the treatment of sports-related knee injuries. Many such injuries are characterized by a high rate of rupture of the anterior cruciate ligament and injuries to the meniscus that are difficult to repair. So far, the search for substitute ligaments to tighten up stretched-out loose ligaments has been unsuccessful. The new so-called Disease Modifying Osteoarthris Drugs (DMOADs) may be able to replace the COX2 drugs, which have been taken off the market. The hope is that the DMOADs will be able to slow down the progressive deterioration which currently seems to be the fate of so many ex-athletes’ knees. |
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