Will orthopaedists be able to keep up?

Driven by the aging baby boomer generation and an increase in the number of obese patients, demand for arthroplasty is projected to double over the next decade. However, according to a paper presented by Thomas K. Fehring, MD, at the American Association of Hip and Knee Surgeons 2008 annual meeting, decreased interest among residents in choosing careers in adult orthopaedic reconstruction is likely to result in a shortage on the supply side.

Dr. Fehring and his team used the AAOS database as well as the 2004 and 2006 AAOS Orthopedic Practice in the United States surveys to calculate the current number of orthopaedists performing arthroplasties in the United States (Fig. 1), as well as the number of joint replacements performed by that group each year.

They found that 7,585 AAOS fellows perform hip and/or knee arthroplasty, including 5,973 general orthopaedists with a hip and knee focus, and 1,612 hip and knee specialists. The two groups perform a total of 337,047 total hip arthroplasties (THAs) and 418,542 total knee arthroplasties (TKAs) in one year.

At best, a minor workforce increase
To estimate the number of arthroplasty surgeons working in 2016, the researchers had to look at both ends of the work force. Not only did they need to determine the number of orthopaedists likely to retire by 2016, they also had to estimate the number likely to enter the workforce with a focus on hip and/or knee arthroplasty.

Assuming that the number of orthopaedic graduates would remain stable between 2008 and 2016, they determined that 1,584 generalists with a hip and/or knee focus and 400 hip and/or knee specialists would enter the arthroplasty workforce.

Calculating the number of retirements depended on the assumed retirement age. Assuming a mean retirement age of 59 years old meant that 3,338 generalists and 901 specialists would retire by 2016. This would result in a 31 percent decrease in the total number of generalists and a 32 percent decrease in the total number of specialists.

When the researchers assumed a mean retirement age of 65 years old, the situation improved con­siderably. In this scenario, the number of generalists performing arthroplasty would increase by 1.6 percent; the number of arthroplasty specialists would increase by 1 percent.

Demand is much greater
The researchers consulted published articles to estimate demand for THA and TKA in the year 2016. Projections indicate that as many as 427,500 THAs will be needed, along with more than 1 million TKAs.

The orthopaedic workforce, however, would only be able to perform 231,071 THAs and 287,759 TKAs in 2016 (using the workforce assumptions of a mean retirement age of 59 years old. That’s a shortfall of 195,929 THAs (46 percent) and 758,241 TKAs (72 percent).

Using 65 years old as the mean retirement age would enable the workforce to perform 339,356 THAs and 422,225 TKAs, leaving a smaller shortfall of 87,644 THAs (20 percent) and 623,775 TKAs (60 percent).

Dr. Fehring pointed out that some experts assume that general orthopaedic surgeons will be willing to meet the additional demand for arthroplasties. The need for additional training, however, coupled with continuing reimbursement reductions for arthroplasty procedures could, over time, result in an “economic disincentive” that will likely prevent many general orthopaedists from entering the arthroplasty arena.

Peter Pollack is a staff writer for AAOS Now. He can be reached at ppollack@aaos.org