JBJS: Orthopedics in 2020
BY LAUREN UZDIENSKI, SEPTEMBER 10, 2009
An article in JBJS outlined the evolving need for musculoskeletal care in the coming decade, addressing changes in demographics, disease incidence, treatment modalities and delivery of orthopedic services. These factors illustrate some of the growth drivers in orthopedics and help project the landscape of the industry in 2020.
One of the biggest factors is the aging of the population. The authors predict that in 2020, the over-65 population will have doubled from current levels to 16% of the U.S. population and 25% of the Canadian population. Life expectancy is also expected to continue to increase. This may raise the risk and incidence of osteoporotic fractures in the population, though hip fracture rates have been demonstrated to be slowing in both the U.S. and Canada, possibly due to heightened awareness, increased screening and therapy, in addition to lifestyle factors like a decline in smoking.
Demand for hip and knee replacements is expected to increase by 2020, with knee replacements, particularly in women, growing at a faster rate. Another driver in this area is the persuasive data on the cost-effectiveness of hip and knee replacements, a consideration that is likely to become more important as payers and other stakeholders focus more prominently on the value of healthcare services. An older population also raises questions about the longevity of implants and revision surgeries. The rate of revision surgeries for hip and knee replacements has already increased 79% over the last decade, and the younger the patient, the more likely they will outlive their implant.
Patients may also be undergoing joint replacement at a younger age, a trend that is exacerbated by rising obesity rates. The authors note that in 2005, 24% of the U.S. general population was obese, and 52% of arthroplasty patients were obese, demonstrating a correlation between weight and surgical candidacy. Obese patients have also been demonstrated to have higher complication rates than their normal-weight peers. While no projections for the obesity rate in 2020 are available, obesity is expected to take a toll on future healthcare costs.
As the demand for orthopedic procedures rises, a question remains about whether physicians and hospitals are equipped to handle an uptick in procedures. An HHS survey conducted in 2006 found that in the U.S., there are 8.7 orthopedic surgeons per 100,000 population and roughly 7.1 full-time equivalents (i.e., physicians who spend 2,200 hours per year in the clinic) per 100,000 population, with that number expected to decline somewhat by 2020; the authors of the JBJS article predict that the decline could be more pronounced than projected based on increased demand based on the aging population, an aging orthopedic workforce and the changing demographics of the surgical workforce. However, the authors caution that the number of orthopedic surgeons in 2020 is challenging to model.
