Future Clinical and Economic Impact of Revision Total Hip and Knee Arthroplasty

Kurtz, Steven M.; Ong, Kevin; Schmier, Jordana K.; Mowat, Fionna; Saleh, Khaled J.; Dybvik, Eva; Kärrholm, Johan; Garellick, Göran; Havelin, Leif Ivar; Furnes, Ove; Malchau, Henrik; Lau, Edmund

doi:10.2106/jbjs.g.00587

Cited by 384 publications

(269 citation statements)

References 11 publications

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“…Kurtz et al (2005) observed a 46% increase in THRs in the USA between 1990 and 2002. This increase is projected to be 174% in 2030, imposing a substantial economic burden on healthcare systems (Kurtz et al 2007a, b). The historical increase in THR is not necessarily the result of a higher incidence of osteoarthritis, but merely an increase in operation rate (Skytta et al 2011).…”

Section: Discussionmentioning

confidence: 99%

Projections of total hip replacement in Sweden from 2013 to 2030

et al. 2014

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Background and purpose The continuously increasing demand for joint replacement surgery in the past decades imposes higher constraints on the budgets of hospitals and healthcare providers. We undertook an analysis of historical trends in total hip replacement performed in Sweden between 1968 and 2012 in order to provide projections of future demand.Data and methods We obtained data on total hip replacements registered every year and on the evolution of the Swedish population between 1968 and 2012. We assumed the existence of a maximum incidence. So we adopted a regression framework that assumes the existence of an upper limit of total hip replacement incidence.Results We found that the incidence of total hip replacement will continue to increase until a projected upper incidence level of about 400 total hip replacements per 105 Swedish residents aged 40 years and older will be reached around the year 2107. In 2020, the estimated incidence of total hip replacement will be 341 (95% prediction interval (PI): 302–375) and in 2030 it will be 358 (PI: 317–396). Using official forecasted population growth data, about 18,000 operations would be expected to be performed in 2020 and 20,000 would be expected to be performed in 2030.Interpretation Growing incidence, population growth, and increasing life expectancy will probably result in increased demand for hip replacement surgery. Our findings could serve as a basis for decision making.

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Section: Discussionmentioning

confidence: 99%

Projections of total hip replacement in Sweden from 2013 to 2030

et al. 2014

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“…As our work here suggests by the early and persistently increased biomechanical strength of bones due to a single day DAPT treatment, a quarter of the time required to resolve normal bone fracture repair could be saved. While the majority of fractures in patients repair with appropriate stabilization and without any pharmacologic intervention, the socioeconomic impact of these injuries cannot be underestimated, as expenses related to treating fractures and associated lost productivity are predicted to increase to over $74 billion by 2015 [51]. Therefore, novel therapies focused on transient gamma-secretase and Notch inhibition, which have been illustrated here to efficiently enhance and accelerate normal fracture healing, could have enormous health and socioeconomic benefits if applied to orthopedic trauma patients.…”

Section: Discussionmentioning

confidence: 99%

Transient gamma-secretase inhibition accelerates and enhances fracture repair likely via Notch signaling modulation

Wang

Shen

Yukata

et al. 2015

Bone

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Approximately 10% of skeletal fractures result in healing complications and non-union, while most fractures repair with appropriate stabilization and without pharmacologic intervention. It is the latter injuries that cannot be underestimated as the expenses associated with their treatment and subsequent lost productivity are predicted to increase to over $74 billion by 2015. During fracture repair, local mesenchymal stem/progenitor cells (MSCs) differentiate to form new cartilage and bone, reminiscent of events during skeletal development. We previously demonstrated that permanent loss of gamma-secretase activity and Notch signaling accelerates bone and cartilage formation from MSC progenitors during skeletal development, leading to pathologic acquisition of bone and depletion of bone marrow derived MSCs. Here, we investigated whether transient and systemic gamma-secretase and Notch inhibition is capable of accelerating and enhancing fracture repair by promoting controlled MSC differentiation near the fracture site. Our radiographic, microCT, histological, cell and molecular analyses reveal that single and intermittent gamma-secretase inhibitor (GSI) treatments significantly enhance cartilage and bone callus formation via the promotion of MSC differentiation, resulting in only a moderate reduction of local MSCs. Biomechanical testing further demonstrates that GSI treated fractures exhibit superior strength earlier in the healing process, with single dose GSI treated fractures exhibiting bone strength approaching that of un-fractured tibiae. These data further establish that transient inhibition of gamma-secretase activity and Notch signaling temporarily increases osteoclastogenesis and accelerates bone remodeling, which coupled with the effects on MSCs likely explains the accelerated and enhanced fracture repair. Therefore, we propose that the Notch pathway serves as an important therapeutic target during skeletal fracture repair.

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“…Biofilm-related infections are among the main reasons for failure of joint prosthesis with high associated social and economical costs [20, 21], often requiring challenging diagnosis and prolonged and complex treatments [22–24]. …”

Section: Discussionmentioning

confidence: 99%

Efficacy of antibacterial-loaded coating in an in vivo model of acutely highly contaminated implant

Giavaresi

Meani²,

Sartori

et al. 2013

International Orthopaedics (SICOT)

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PurposeThe purpose of this study was to test the ability of DAC®, a fast resorbable, antibacterial-loaded hydrogel coating, to prevent acute bacterial colonization in an in vivo model of an intra-operatively highly contaminated implant.MethodsA histocompatibility study was performed in 10 adult New Zealand rabbits. Then, methicillin-resistant Staph. aureus were inoculated in the femur of 30 adult New Zealand rabbits at the time of intra-medullary nailing; vancomycin-loaded DAC® coated nails were compared to controls regarding local and systemic infection development.ResultsHistocompatibility study showed no detrimental effect of DAC® hydrogel on bone tissue after 12 weeks from implant. After seven days from implant, none of the rabbits receiving vancomycin-loaded DAC® nail showed positive blood cultures, compared to all the controls; vancomycin-loaded DAC® coating was associated with local bacterial load reduction ranging from 72 to 99 %, compared to controls.ConclusionsVancomycin-loaded DAC® coating is able to significantly reduce bacterial colonization in an animal model of an intra-operatively highly contaminated implant, without local or general side effect.

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Future Clinical and Economic Impact of Revision Total Hip and Knee Arthroplasty

Cited by 384 publications

References 11 publications

Projections of total hip replacement in Sweden from 2013 to 2030

Projections of total hip replacement in Sweden from 2013 to 2030

Transient gamma-secretase inhibition accelerates and enhances fracture repair likely via Notch signaling modulation

Efficacy of antibacterial-loaded coating in an in vivo model of acutely highly contaminated implant

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