Why Physicians Must Be Involved in Joint Replacement Strategies

Joe Cantlupe, for HealthLeaders Media , September 29, 2011

Moreover, physicians should play key roles in the decision-making process for implant purchases, Naas says. Within the hospital, a special "value-analysis team" that includes physicians should be established to have a direct relationship with sales representatives of implant device makers to negotiate cost and standardize programs for improved purchasing, Naas says.

With so many orthopedic devices in the marketplace, the government is trying to evaluate the cost and impact, especially those related to hip and knee replacements, by establishing a $12 million database, or "registry" of the products. The Agency for Healthcare Research and Quality wants to know if these devices work over the long haul, and how expensive are they.

While orthopedic devices are promoted by "surgeon enthusiasts" of particular device/procedures, AHRQ says in a planning document that "the real-world clinical performance of the devices outside of the leading centers that participate in pre-market clinical trials is difficult to evaluate."

"There are thousands of devices and device combinations in use to perform hip and knee replacement and repair procedures," AHRQ states. "The comparative effectiveness of these devices is unknown."

The American Academy of Orthopedic Surgeons has been lobbying for a federally supported national hip and knee replacement registry for years.

Naas says developing a nationwide registry of orthopedic devices will improve clinical outcomes and reduce costs. "In these registries, long-term outcomes are followed for total knee or total joint replacement," Naas says. "We don't have a national registry in the U.S. There are individual health systems that have their own registries, but there is not one specifically for this country. Other countries have them."

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