Healthy Skepticism Library item: 5918

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Publication type: news

Metherell M.
One in four hip, knee replacements needs redoing
Sydney Morning Herald 2006 Aug 22
http://www.smh.com.au/news/national/one-in-four-hip-knee-replacements-needs-redoing/2006/08/21/1156012474008.html

Full text:

One in four hip, knee replacements needs redoing

http://www.smh.com.au/news/national/one-in-four-hip-knee-replacements-needs-redoing/2006/08/21/1156012474008.html

Mark Metherell
August 22, 2006

A QUARTER of joint replacement operations in Australia fail, requiring
patients to undergo expensive and painful repeat surgery, according to
the draft findings of a national survey.

About 65,000 joint replacements, mainly hips and knees, are performed
every year in what is a rapidly growing branch of surgery because of the
ageing population. It costs $1 billion a year.

Health insurance companies have called for a more rigorous assessment of
joint prostheses by orthopaedic surgeons and the Therapeutic Goods
Administration. The chief executive of the Australian Health Insurance
Association, Michael Armitage, said that apart from the increased
suffering of patients from complications such as deep-seated infections,
the so-called joint revisions increased health insurance costs by more
than $100 million a year.

His organisation is targeting the artificial joints issue on a new
website, healthalerts.com.au, to canvass consumers’ support for the
health funds by stepping up the focus on health, safety and quality issues.

People with health insurance believed the funds should play a greater
role in ensuring their policyholders got the best care.

The website would pursue other issues, like that posed by the
“disturbing” problems with joint replacements, Dr Armitage said.

The figures collected by the National Joint Replacement Registry showing
the 25 per cent revision rate are expected to be released by the
Australian Centre for Health Research next month.

Dr Armitage said that while the results were similar to those in many
other Western countries, Australia should work towards matching the
world’s best outcomes set by Sweden, where the revision rate was about
half that of Australia’s.

If this were achieved, health funds could save as much as $160 million a
year, he predicted. One of the problems appeared to be the wide
variation in the quality of the many prostheses on offer and inadequate
testing of the devices before they were introduced in Australia.

About 130 different hip prostheses and 60 different knee prostheses are
available.

Dr Armitage said he had been told that not a single new joint prosthesis
had performed better than earlier models and “many have higher revision
rates”.

The director of the joint replacement registry, Professor Stephen
Graves, who has previously said that any joint revision was “an
unambiguous indication of failure”, told the Herald he could not comment
on the registry’s figures until they were finalised and made public.

The president of the Australian Orthopaedic Association, George
Sikorski, denied Australia’s approach to joint replacement was lax.

The association was keen to see a more rigorous evaluation of
prostheses, “as does everybody”, and the registry’s aim was to pick up
emerging problems, he said.

The Australian Orthopaedic Association “will support the use of the
best-performing prostheses once they are identified, no doubt about that
at all”.

“We would support the insurance industry in this … there is absolutely
no one who gets any kudos in being associated with a bad product.”

Mr Sikorski, who is a surgeon in Perth, said the association’s
development of a national registry put it ahead of many other countries,
particularly the United States, in being able to identify poorly
performing joint prostheses.

In the US it could sometimes take hundreds or even thousands of
operations before faulty prostheses were identified, whereas in
Australia, the national registry meant it took 20 or 30 cases for the
faults to be acted on.