The Season for Giving— Knee Replacements

This is the time of year for giving, and that even extends to hip and knee replacements. Thanks to Operation Walk, 200 people in the US received free joint replacements last week. However, at the risk of putting a damper on this charitable cause, three of those patients will likely need revision surgery within three years.

One in every 75 people requiring revision surgery is a conservative statistic given the manufacturers who donated the medical devices. Some knees and hips came from Zimmer, DePuy, and Stryker. All three medical device manufacturers have been named in lawsuits for defective and recalled knee and hip implants.

The DePuy hip track record is particularly concerning. Between 2007 and 2009, the Australian National Joint Replacement Registry warned DePuy 17 times about ASR problems, including a revision rate twice the normal expectancy rate of 15 years. (The Australians were the first to implement a registry; The American Joint Replacement Registry was founded in 2011 to track the 700,000 total hip and knee replacements performed each year in the U.S.) DePuy removed its product from the Australian market in 2009, citing decreased demand, but left it on the market in the US and other countries for a few more years.

Some of these 200 recipients are suffering from arthritis. At the Hofmann Arthritis Institute in Salt Lake City, doctors donated their valuable time to provide free surgeries to eight people from Utah and Idaho as part of Operation Walk USA 2012. With these patients, hip and knee replacement is even riskier. According to The Journal Arthritis & Rheumatism (11/28/12) patients with rheumatoid arthritis are at higher risk of dislocation following total hip arthroplasty and higher risk of infection following total knee arthroplasty.

The Los Angeles Times reported that seven local residents will receive free hip and knee replacements at Keck Hospital of USC and that all of the medical care, including surgery, hospitalization and post-operative treatment, will be covered. One cannot help but wonder if post-operative treatment will extend to revision surgery.

Nationwide, the number of knee replacements is escalating. More than 3 million Medicare patients got artificial knees from 1991 to 2010. Of those, about 10 percent were revisions, according to a study by University of Iowa researchers published last month in the Journal of the American Medical Association.

“There‘s a never-ending supply of patients who need revision,” said Dr. Brian Hamlin, an orthopedic surgeon at Magee-Womens Hospital of UPMC and associate director of its Bone and Joint Center. Nearly a third of the 400 hip and knee replacement surgeries he performs every year are revisions.

One major factor for the rise in revision surgery is wear and tear??”increasingly younger people are getting hip and knee replacements. And for those people who received a hip or knee in the 90s, it is simply wearing out??”the life span of a hip or knee replacement is about 15 years. Chalk up some revisions due to technical errors. “People have subtleties to their anatomy that aren‘t recognized,” said Dr. Hamlin who also added that some people experience implant failure within two years of surgery. In most of those cases, an infection or unstable joint is to blame. The hip, for example, pops out of its socket due to it being a defective device.

In 2011 alone, the FDA reported more than 12,000 problems with metal-on-metal devices. One serious side effect of these metal-on-metal hips and knees is metallosis, which is caused by these devices shedding metal particles into the bloodstream, resulting in chronic pain and infection.
It is not known if the 200 patients participating in Operation Walk USA 2012 received metal-on-metal hip and knee replacements.

According to Operation Walk, it provided life-changing hip or knee replacements for 85 patients in 2011, the first year it reached out to patients in the US. (Operation Walk is an international volunteer medical service organization that provides treatment for patients with arthritis and joint conditions in developing countries.) Indeed, hip and knee replacement surgery is life-changing??”let’s wish it is a positive change.