Bringing together patients and researchers
Healthcare costs of hip replacements
Bringing together the public and researchers
We believe that lessons must – and can – be learned from the failure of the metal-on-metal hip replacements. In order to do so the views of many stakeholders need to come together so we can avoid relying on only one aspect of the story.
The needs and anxieties of people with metal-on-metal hip replacements and their families, for example, need to be recorded and inform how we think about the issues and how we approach them.
We believe that bringing together different understandings and insights provides a unique opportunity to help improve both research and the way that, for example, people with metal-on-metal hip replacements can claim a stake in the unfolding story.
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Our three main goals are:
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Since the 1950s, the life expectancy of people in the UK has increased considerably. Within only a few decades, people in the UK have experienced much longer life-spans at almost all levels of society than ever before.
Changes in social relationships, and improvements in healthcare, nutrition and sanitation have, together with the ‘baby boom’ of the 1960s, contributed to a larger number of over 65-year olds living in the UK today than those aged 16 and under.
When people live longer they want to stay active for longer: to be mobile, remain productive, and to be independent. Much public and philanthropic effort is being invested into developing technologies, services and other ways of ensuring that the increasingly large population of older people can continue to enjoy a good quality of life.
However, according to a Parliamentary brief on ageing from 2010, “healthy life expectancy has not ... increased as fast [as life expectancy], resulting in proportionally greater demands on public services such as the NHS.” A result is that healthcare and social care costs are increasing together with greater life expectancy.
Healthcare costs of hip replacements
The replacement of diseased and failing joints (hip, finger, shoulder, ankle or knee) is one of the best ways of re-establishing mobility, and as such independence, of people who suffer from illness- or age-related pain and limitations of their joints.
Replacement procedures pose a considerable investment of time, effort and finance but this is offset by the increase in independence of patients.
In England and Wales The National Joint Registry (NJR) recorded more than 65,000 hip replacement procedures for 2009 alone. Each primary joint replacement costs around £6,000.
However, if prostheses do not function as intended, they need to be replaced (revision). Whilst the original joint replacement might have been intrusive in patients’ lives, a revision means more surgery and longer healing times for patients. The costs here can be many times the original replacement, up to £25,000 plus expenses for a prolonged hospital stay.
In 2009, over 7,200 revision hip replacement procedures took place in England and Wales according to the NJR, with an estimated cost of up to £180 million.
In an ageing society, the social burden of such surgery in an increasingly older population will only continue to increase. Equally, the personal burden of patients and their families cannot be overlooked. Therefore, one way of approaching the improvement of hip replacements is to learn from mistakes at the engineering, the hospital and the social level.
Together with the growing number of older people worldwide, the numbers of orthopaedic surgery has increased. Although in most cases people with hip implants enjoy improvements after having received joint replacements, sometimes devices fail to fulfil expectations, even of healthcare professionals and engineers. Such failures can have a considerable personal, financial and social impact.
People with hip implants might suffer from increased pain and inflammations, necessitating revision procedures, which in turn lead to increased costs for the public health service, and again to a greater social burden for individuals, their families and society. People might also lose trust in developers and producers of medical devices, and also in clinical science and medicine.
Healthcare-related incidents over the past three decades have shown that whilst science and medicine can be beneficial to people and society, they can also cause worry. Often, doubts arise over individuals failing to make the right – or appropriate – choice as a BBC News item from 2 April 2006 reported.
In the late 1990s two designs of the total hip replacement system 3M Capital Hips produced considerable failures particularly in younger patients and men. Revisions were hindered by a lack of hospital and national records of the number and places of hip surgeries, exposing patients to greater risks through continued wear of the failed devices. An investigation by the Royal College of Surgeons of England, with patients, led to a range of recommendations. One of these recommendations was to establish a national register of joint replacement surgeries (the National Joint Registry), which was started in 2002. Whilst hospitals and the NJR have since kept records of hip replacements in the UK, further cases of failures have occurred, such as with the metal-on-metal hip replacements PinnacleTM and ASRTM by DePuy.