Arthritis and the global business of hip replacements


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Who’d have known there were 2.150 million Australians who suffer from arthritis? It was one of the questions in the 2021 Census (asking about long-term health problems). I don’t recall answering the question, but don’t doubt that I ticked the top 3 boxes.

The three biggest long term health issues in Australia are: mental health, arthritis and asthma.

The 2021 Census was the first time the Australian Bureau of Statistics (ABS) asked about diagnosed long-term health conditions. Two million-plus people reported having at least one of the top three – mental health (2,231,543), arthritis (2,150,396) and asthma (2,068,020).

Of those who responded to the survey, 4.78 million reported having one of the 10 long-term health conditions; 1.49 million reported having two of the health conditions and 772,142 had three or more.

Let’s focus on health issue number two – arthritis. There’s a bit of it in my family and when the weather is cold or I have been playing guitar, typing or weeding, ‘Arthur’ reminds me he is king of my castle.

So far it is just swollen hand joints (thumb and pinkie) and occasional pain in the hip and femur. Despite having major surgery on both knees in 1969, I’ve ducked the serious inflammation that attacks hips and knees.

I once met the late jazz musician, Don Burroughs, who suffered with arthritis in later life. He told me he’d successfully taught himself different techniques for playing clarinet, flute and saxophone. Veteran guitarists will tell you similar stories of how to play, holding the instrument in different positions.

The Australian Institute of Health and Welfare shed some light on the subject in 2020 with a report that looked at an array of musculo-skeletal conditions that affect the bones, muscles and joints. These conditions include long-term (chronic) conditions such as osteoarthritis, rheumatoid arthritis, juvenile arthritis, back pain and problems, gout, and osteoporosis or osteopenia (low bone density).

The latter caught my attention as I recently checked in with the Bone Bus and had scans done of my hips, knees, spine and upper arms.

The Bone Bus is a travelling clinic with the sole purpose of measuring patients’ bone density. The scan is one of three procedures people over 70 can have that is wholly funded by Medicare. I had the pneumonia and shingles vaccines about 18 months ago. But ever since then, I was away travelling when the bone bus came to town.

According to John Hopkins Medicine, a bone density test is used mainly to diagnose osteopenia and osteoporosis. It is also used to determine your future fracture risk.

I have not seen a doctor about my scan yet (it can take a week to see a GP in this town – or any other for that matter), but I’m fairly relaxed about it. I’ve had a couple of tumbles in the garden and in the house in recent years and suffered only bruises of the flesh and ego.

Not so for some of my peers, who have either had a hip or knee replacement or fractured a hip after a fall.

Friends who broke a hip report a good rate of recovery. One friend was back driving six weeks later. Another was getting about town on a walking stick within a month.

The main issue when an older person falls and fractures a hip is the risk of death. The one-year mortality rate after hip fracture is 21%, once the fracture is surgically addressed. If not, the one-year mortality is about 70%.

This means 4 out of 5 older persons will survive the first year after a hip fracture. This mortality rate has remained unchanged since the 1980s.

The Conversation goes one step further, saying a hip fracture can often be a ‘death sentence’. The statistics around hip fractures in the elderly are alarming, notably that 27% of hip fractures occurred after a fall in an aged care facility.

Age is a key risk factor, with hip fractures more likely to occur in those aged 65 or older. They’re primarily a result of a fall, or when the hip collides with a solid object such as a kitchen bench. However, they can also occur when there has been little or no trauma.

Cognitive impairment such as dementia can increase the risk of falling. Frailty, poor vision, the use of a combination of medications, and trip hazards in the home also increase the likelihood of falls. Osteoporosis, a disease characterised by low bone mass and degradation of bone tissue, is another significant risk factor for hip fractures.

Data from the AIHW  collated in 2017 found that 93% of new hip fractures were the result of a fall-related injury, of which 87% were minimal trauma (low-impact) falls. Nearly half (48%) occurred in the person’s private home, and, as mentioned, 27% occurred in an aged care facility.

Falls and fractures aside, if your hips are problematic, replacement surgery with advanced robotics and titanium prosthetics is the preferred option to waiting for the inevitable fall.

The hip replacement procedure has improved greatly since it started to become commonplace in the early 1990s. This YouTube video explains by animation how a compromised hip joint is replaced.

Osteoarthritis is usually the condition that leads to requiring a hip replacement. People with bad hips do have options (first line of treatment is anti-inflammatory drugs). Eventually, though, GPs are more likely to suggest a hip replacement than not. The technology for the procedure has improved to the point where the successful, pain-free recovery rate is above 95% and 90%-95% at the 10-year mark.

Surgeons have been able to replace worn-out or diseased hip joints since the 1960s, but it wasn’t until the late 1980s that people began actively seeking it out as an option.

About 44,000 Australians sign up for a hip replacement every year with more than 90% reporting a good outcome.

An article attributed to Fortune Business Insights shows that hip replacement surgery is a $US6.57 billion global business. Despite a 12.1% decline in turnover through 2020 (as Covid postponed elective surgeries), the business of replacing hips is huge.

Globe Newswire reported that the global market size is projected to hit US9.91 billion by 2028. The forecast growth is due to the “growing prevalence of osteoarthritis in the geriatric community.

The market’s growth is also attributable to “favourable health reimbursement policies.

We are fortunate in Australia that such procedures are paid for by Medicare, albeit after a lengthy waiting period. A hip replacement can cost between $19,439 and $42,007 (median $26,350). You probably know people who have had both hips done. Three cheers for free medical care (introduced by Gough Whitlam in 1974 and further enhanced by Medicare in 1984).

Meanwhile I should, I know I should, go back to the aged person’s gym that focuses on stretching and flexing, working on the all-important core strength which helps us keep our balance.

As for knees, which are more problematic, I already wrote about that.

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