A study posted by another physician popped up on Twitter the other night projecting that there will be a 600% increase in the number of total knee replacements performed by the year 2030! I don’t agree, as this doesn’t take into account the quiet revolution occurring behind the scenes in the use of orthobiologics that will make metal, plastic, and ceramic knee replacement devices obsolete. However, the idea that there will be a 600% increase in severe knee arthritis is troubling. First, let’s start by going over some knee replacement facts…
What Is a Knee Replacement?
Unlike replacing a worn-out part in your car, and despite the TV commercials and marketing of knee replacements to a younger and more active audience, knee replacement is a massive surgery in which the natural knee joint is amputated and a metal and plastic prosthesis is inserted. It is also referred to as a total knee replacement (TKR) and a total knee arthroplasty, (TKA). The intention is admirable: to surgically remove a joint so arthritic and damaged that it is causing great pain and lack of function and to return the patient to the level of activity that preceded their arthritis. There are, however, several problems that arise because of the invasiveness of the procedure.
Knee Replacement Facts: Risks and Complications
Some things to consider from many different studies on knee replacement follow:
- Less than 40% of people return to full activity after a knee replacement.
- Despite pain being the most common indication for surgery, the most common complication of knee replacement surgery is chronic pain.
- The younger and more active you are, the more likely your new knee is to fail!
There is another issue. The major push by device manufacturers to push more product sales has caused a new problem: knee replacements are being performed on patients where the knee joint hasn’t been established as the cause of pain. Studies have estimated that one-third of knee replacements performed today are medically unnecessary as they are based on findings on X-ray and MRI that are incidental. As a matter of fact, we would struggle to not find meniscus tears, cartilage damage, and arthritis in any middle-aged or older group of patients.
How can someone with knee pain and arthritis not need a knee replacement? The pain may be from somewhere else as most people who are middle-aged or older have something wrong with their knee on an MRI scan. These other things that cause knee pain include low back issues, SI joint dysfunction, and painful local tendons, muscles, ligaments and nerves. In these patients amputating the knee doesn’t do much good!
Other somber and well-known knee replacement risks include stroke, heart attack, and blood clots, and there’s the lesser known phenomenon of allergic patients having poorer results and more pain with knee replacement. If you’re considering this invasive surgery, check out “5 Knee Replacement Questions to Ask Before Surgery.”
The new study looked at strategies for the management of infection caused by knee replacement surgery. While the rate of serious infection was 2%, the projected number of infections by the year 2030 was 70,000! How did they get that number? They used a 2007 study that had concluded that based on the data from inpatient hospital stays and census data they had at the time, the number of knee replacements would increase by 600% by the year 2030!
The upshot? While there is an explosion in the number arthritis cases that are occurring, the knee-device manufacturers shouldn’t be licking their chops quite yet. I expect that we’ll see a decline in the total number of knee replacement surgeries that are performed by 2030. This will happen due to advances in interventional orthopedics and orthobiologics. While that’s a bummer for Wall Street betting on Stryker and Dupuy, it should be a huge win for patients!