The Osteoarthritis Epidemic
As the massive Baby Boom generation advances in age they’re marching forward on increasingly creaky knees, and every crack, click and pop is an audible reminder of the growing impact that treating osteoarthritis will have on the U.S. health care system for decades to come.
Osteoarthritis, degenerative arthritis and the joint replacements that sometimes follow, already constitute a top 5 health expenditure, estimated at nearly $14 billion per year by the Agency for Healthcare Research and Quality. Currently, more than 20 million people in the United States need non-operative management for osteoarthritis, and nearly 1 million will have joint replacement surgery.
Those figures are expected to double over the next 20 years.
“There is an onslaught coming of people who are going to need joint replacements,” said Kurt Spindler, M.D., Kenneth D. Schermerhorn Professor of Orthopaedic Surgery and Rehabilitation at Vanderbilt.
“No matter what we do, joint replacements are going to go up, and we need to meet these needs by increasing capacity and better managing outcomes earlier on.”
As with many chronic conditions, prevention and early diagnosis are the keys to improving osteoarthritis-related outcomes and reducing or delaying the number of surgical procedures, such as arthroscopic ligament, cartilage and meniscus repair as well as joint replacements.
It’s here where Vanderbilt truly shines, thanks to its leadership in several multi-center prevention and treatment studies and the institution’s commitment to evidence-based medicine.
• The Multicenter Orthopaedic Outcomes Network (MOON), led by Spindler, is a longitudinal study of 2,500 patients who have had anterior cruciate ligament (ACL) reconstruction to identify predictors of successful reconstruction.
According to Spindler, these patients offer a good study model, as the changes seen in the knee following ACL injury mimic the changes seen in degenerative arthritis, only they occur much more rapidly. Also, knee trauma is a primary risk factor for developing arthritis later in life.
• Vanderbilt is also taking part in the NIH-sponsored MeTeOR trial, which involves eight centers and is led by Jeffrey Katz, M.D., co-director of the Brigham Spine Center at Brigham and Women’s Hospital in Boston. This study is examining the benefits of arthroscopic surgery vs. rehabilitation for people over age 45 who have both arthritis and a tear of the meniscus.
Spindler said the results of this study, due out within the next year, will play a role in determining Medicare reimbursement rates for knee arthroscopy in the future.
• Frank Harrell, Ph.D., chair of Vanderbilt’s Department of Biostatistics, has developed a statistical model to predict outcomes following ACL surgery. Using characteristics such as age, body mass index, smoking history, mechanism of injury and activity level, Harrell’s model can predict — for individual patients — the risk of reinjuring the knee as well as future levels of knee pain.
“Everyone thinks personalized medicine is looking at your genome to figure out what’s going on,” Spindler said. “That’s true, but it’s also about statistical modeling based on patient characteristics. There will be people six years after an ACL injury who have no arthritis and no pain, and we’ll leave them alone.
“Let’s identify the people who are going to have pain, are going to have arthritis and let’s figure out how to modify their risk factors. This statistical modeling is what physicians need to make decisions based on the individual patient, which is what personalized medicine is all about,” Spindler said.