They expire like the washing machine or the refrigerator: even the devices that allow us to recover a compromised joint function, such as running, jumping or climbing stairs, defined in 2007 by the Lancet as “the intervention of the century”, do not last forever and over time they meet the need for a “service”. An exponentially growing demand in the United States which also applies to Italy, due to the progressive increase in patients who will live longer than their prostheses, which have an average lifespan of around 20 years, due to the expansion of the expectation of life and the increase in young people, under the age of 60, who ask to undergo this operation.
Interventions are increasing
“The number of operations for the implantation of orthopedic hip, knee and shoulder prostheses continues to increase in Italy, which in twenty years have almost tripled, going from 80 thousand in 2000 to over 220 thousand in 2022, according to the most recent Agenas data. An unthinkable quantity of implants which places Italy among the first places in Europe for the number of prostheses implanted in all joints and for the levels of reliability. The most frequent cause is osteoarthritis which tends to degenerate with age “, he declares Claudio Zorziamong the leading experts, president of the congress and director of Orthopedics and Traumatology of the IRCCS of Negrar, which precisely by virtue of the excellence achieved in the field of prosthesis revision is among the centers with the highest caseload in Italy and a regional reference.
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“However – adds the expert -, although modern technologies have managed to create very high quality prostheses, the physiology of the joint subjected to prosthesis surgery is still very different from the natural one and there may be many factors that influence its good functioning: starting from the natural loosening of the moving parts, to excessive overload use, especially in younger patients or those who are overweight, up to infections, or the very rare breakage of the prosthetic components. Problems that must be addressed before serious damage is caused to the bone and ligament structures”.
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The duration of the system
Even if today it is still not possible to have a precise prediction of the duration of the implant for each patient that takes into account the many variables involved such as age, sex, the type of prosthesis used, it can be estimated that prostheses will still be “good” 15-20 years after implantation, in 90% of cases, according to a large study published in the Lancet by researchers at the University of Bristol. In fact, it is estimated that every year there are over 20 thousand prostheses that need a service, equal to 10% of the over 220 thousand prostheses implanted annually to date. A phenomenon destined for exponential growth, in line with American data which predict record increases of 137% for the revision of hip prostheses and up to 600% for the replacement of knee prostheses, due, on the one hand, to the fact that the elderly are living longer and longer and, on the other, the increase in young patients, under the age of 60, who decide to undergo this operation.
15-20 years
“Estimating an average lifespan of the prosthesis of around 15-20 years, it is clear that a young patient who received the indication for a prosthesis under the age of 60, or even an elderly patient who underwent the implant around the age of 70, “wear out” their prosthesis at an age in which the functional demand or the absence of pain is still high and makes a revision necessary”, explains Antonio Campacci, head of hip surgery at the IRCCS of Negrar and vice-president of the congress together with my colleague responsible for shoulder surgery, Paolo Avanzi “The implantation of a prosthesis is a one-way street, if it fails there is no going back and only a further prosthesis will be able to try to guarantee joint function that lasts over time”, underlines Campacci.
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A very complex procedure which for its success requires highly specialized centers and expert surgeons which it is hoped will increase throughout Italy in light of the exponential increase in revisions. A possible shortage risks creating thousands of disabled people if the review fails, with significant costs for the National Health Service.
“The habit of dealing with the prosthetic problem, already important in the first implants, becomes essential in revisions, in which practice and experience greatly reduce the risks of patients not achieving normal self-sufficiency”, points out Zorzi.