Sunday, October 29, 2006

Joint Replacement Strategies

The symposium I attended this week was organized to discuss strategies to improve efficiencies in knee and hip replacement surgery and rehabilitation. In Canada, we have a publicly funded health system that operates with dollar caps. This leads to waits for orthopedic, cardiac, ophthalmologic and even cancer surgery. The present demand for joint replacement surgery in the boomer generation is growing so quickly, that in five to seven years these procedures will potentially consume the total health budget of Ontario, so savings must be found. Each replacement costs between $10-12,000 CDN and patients sometimes have multiple joints surgeries. The average life of an artificial joint is ten years so more costly revisions are ahead for many people. The same situation exists in United States and other western nations.
We heard speakers talk about improving post operative pain control, decreasing hospital stays to one to three days, increasing the number of micro-procedures, using nurse practitioners, physician assistants and advanced practice physiotherapists to provide less expensive follow up for patients. During a question period, someone asked, “Why are we trying to find ways to do more surgeries, instead of trying to find ways to make this surgery obsolete?" There was absolute silence from the presenter’s forum.
We generally loathe making lifestyle changes to improve our health. How much easier it is to take a pill or have some surgery. Yet pharmaceutical companies push their drugs, surgeons welcome more cases, costs escalate and our health is not improved. Nine out of ten people requiring knee replacements are overweight or obese, and eight out of ten people requiring hip replacements are the same. The connection between smoking and lung cancer, and obesity and diabetes has entered public knowledge, but the link between weight and arthritis is less well understood. There are other causes of hip and knee arthritis including flat feet and improper foot wear, inadequate exercise, previous joint injury, and inflammatory conditions such as rheumatoid arthritis. The majority of cases going to surgery could be improved or delayed with earlier preventative intervention. There are concerns that today’s increasingly obese children will experience an early onset of joint problems.
I decided not to give therapy advice in this blog, but I will recommend a great book for the general public called Strong Women and Men Beat Arthritis by Miriam Nelson.
I wonder what health workers in third world cultures think of the money spent on treating health problems which are created by our excesses, as they work with inadequate resources to treat basic health needs of the poor?


  1. My husband has knee troubles (and diabetes) and is overweight.

    The knee troubles he blames on doing concrete work for many years, his doctor says he is too young for knee replacement and only suggests steroid shots.

    He puts up with the pain and walks like an old man sometimes.

    Thanks for the book link - I'll have a peek.

  2. No doubt your husband's work contributed to his pain. But each pound of weight can put up to 6 pounds worth of pressure on the knee joint during activity. So losing even 10 pounds can make a significant difference in the knee pressures. Small goals are best for most people. Good luck!


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