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Redoing hip surgeries are costly, says new study

Redoing hip and knee replacements costs Canada’s health system $130 million a year, says a report from the Canadian Institute for Health Information (CIHI).
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Redoing hip and knee replacements costs Canada’s health system $130 million a year, says a report from the Canadian Institute for Health Information (CIHI).

“While the demand for hip and knee replacement surgeries continues to grow, repeat surgeries are an area that can benefit from improvements in short- and long-term revision rates,” says the CIHI in a statement released on Thursday.

In 2016, eight per cent of hip and knee replacement surgeries were for “revisions,” which refers to surgeries to replace or fix original joint replacements. That percentage represents 9,400 surgeries, which cost an average $13,700 each.

In Alberta from 2016-17, there were 1,140 revision surgeries that cost $15.6 million in patient spending, not counting physician and rehabilitation costs.

Hip and knee replacement is becoming an increasingly common surgery. Between 2012 and 2016, the number of hip replacement surgeries in Canada grew by 18 per cent to 56,000 annually. The number of knee replacement surgeries increased 16 per cent to 67,000.

Over the same five years, the number of hip revision surgeries decreased by 16 per cent. Knee revision numbers remained flat.

“The need for a repeat surgery — particularly shortly after the first one — is an especially negative outcome for the patient’s quality of life, and it costs the health care system a lot of money,” says Nicole de Guia, manager of CIHI’s joint replacement registry.

“That’s why it’s important to look for opportunities to continue to reduce these additional surgeries.”

In a study of 250,000 patients, CIHI found a revision rate of 2.4 per cent within four years, which was generally within guidelines found in the United Kingdom.

“However, it is important to note that these early revisions are preventable surgeries, as they are intended to last for 15-20 years and therefore revision surgeries done earlier than that have significant implications for the health care system and for patients’ quality of life,” says CIHI.

Besides the additional cost, return trips for knee and hip patients often involves more involved surgery. The average hospital stay for revision hip surgery is six days, and for knee surgery four days.

Red Deer orthopedic surgeon Dr. Keith Wolstenholme said the national numbers are “probably on par with what we see” in Central Alberta.

Wolstenholme said most of the revisions he sees at Central Alberta Orthopedics are related to wear and tear.

“Usually over time, the parts, essentially, wear out,” said Wostenholme. “Any knee or hip replacement, essentially, has a life expectancy on it.”

Whether the parts wear out in five years or 10 years or more depends on many factors, including other medical issues or what the patient weighs or how active they are.

“Eventually, if a patient lives long enough they will wear out their components.”

That is one of the reasons, delaying hip or knee replacement surgery as long as possible is often recommended. It potentially spares a patient a return surgery visit.

Wolstenholme said Red Deer patients heading in for knee or hip surgery are usually out of hospital in a day.

“That’s actually quite good. That probably puts us ahead of the curve in most places.”

He also expects Canada stacks up well as far as revision surgeries are concerned.

He is not surprised that the CIHI is looking at hip and knee replacements and how long they are lasting.

“(Hip and knee replacements) tend to be a huge component of surgical volume.”

As more hip and knee surgeries are done on younger patients, the revision numbers may climb. But it is a fine line on whether it is better for the quality of life of patients to delay replacements to spare them possible revision surgery or to alleviate their pain knowing they will likely have to come back again years down the road.

CIHI says it will continue to monitor and report on trends in revision surgeries as well as study the factors that led to patients going back under the knife early.

“It is important for decision-makers and clinicians to continue to stay abreast of the evolving evidence in this area in order to make the best decisions for optima patient outcomes.”

The CIHI is an independent, not-for-profit organization that gathers information on Canada’s health system and the health of Canadians to promote improvements.