The Changing Landscape of Orthopedics
With major shifts in the business and the
practice of joint surgery come new challenges and opportunities.
A
late-afternoon hip revision
add-on is a cruel way to
end a busy surgeon's busy
day, but it struck me after I fin-
ished that case that revision sur-
gery is symbolic of orthopedics
today. Let's put aside for a
moment that revision arthroplasty
is a technically challenging sur-
gery to perform — I can do 5 pri-
mary hip replacements in the 4
hours it takes to do a single hip
revision! — and that the reim-
bursement is paltry. Instead, let's
focus on what the increase in joint
revisions says about the state of
our specialty.
• Revision burden. First, it tells
us that patients are outliving their
original joint implants, which for
most patients last 10 to 20 years.
We can expect a steady stream of
revisions (the so-called "revision burden"), not just because more
and more people are undergoing joint replacements, but because the
revision rate for hip and knee replacement patients is 6% after 5
years and 12% after 10 years, studies show. Keep in mind that revi-
4 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • A U G U S T 2 0 1 8
On Point
P. Maxwell Courtney, MD
• ONE OVERNIGHT Researchers say next-day, rather than
same-day, discharge for some Medicare patients who undergo
joint replacement represents the "sweet spot" for minimal
complications.
