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The Prevalence of Disabling Musculoskeletal Conditions and the Demand for Orthopedic Surgery in the Twenty-First Century

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Perioperative Care of the Orthopedic Patient

Abstract

The majority of hospitalizations and indications for surgery for musculoskeletal conditions result from degenerative diseases of the spine and major lower extremity joints. Spinal surgery, which follows careful selection criteria, typically results in pain relief, improved function, and improved quality of life which is maintained over long term periods of observation. Complications following spinal surgery are affected by age of the patient, anatomic location of disease and the surgical approach. Older patients with preexisting comorbidities, posterior approaches to the cervical spine and anterior approaches to the thoracolumbar spine are associated with higher risks of postoperative complications. Rapid growth in the demand for total hip and total knee arthroplasty has occurred over the past decade reflecting aging of the population as well as the success and safety of these procedures. Morbidity and mortality following total hip replacement (THR) and total knee replacement (TKR) are rare and the incidence of complications and death has decreased over time. Thromboembolic events have been reduced with adoption of routine prophylaxis protocols. Myocardial infarction occurs in approximately 3 % of patients and stroke in 0.5 %, and patients over 70 years of age appear to be at greater risk.

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References

  1. Jacobs JJ. The burden of musculoskeletal diseases in the United States: prevalence, societal and economic cost. Rosemont, IL: The United States Bone and Joint Decade; 2008.

    Google Scholar 

  2. National Center for Health Statistics (2004) National hospital discharge survey 2004.

    Google Scholar 

  3. National Center for Health Statistics (2004) National health and nutrition examination survey data 1998–2004.

    Google Scholar 

  4. Agency for Healthcare Research and Quality (2004) Healthcare cost and utilization project, nationwide inpatient sample.

    Google Scholar 

  5. Deyo RA (2011) Epidemiology of spinal surgery, Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington. http://depts.washington.edu/ccor/studies/SpineSurgEpi.shtml. Accessed on November 26, 2011.

  6. Ong K, Lau E, Kurtz S, et al (2007) Cervical, thoracic, and lumbar fusion rates in the U.S.: perspective from two health databases. 53rd Annual Meeting, Orthopaedic Research Society, 2007.

    Google Scholar 

  7. Abraham DJ, Herkowitz HN, Katz JN. Indications for thoracic and lumbar spine fusion and trends in use. Orthop Clin North Am. 1998;29:803.

    Article  CAS  PubMed  Google Scholar 

  8. Amundsen T, Weber H, Nordal HJ, et al. Lumbar spinal stenosis: conservative or surgical management?: a prospective 10-year study. Spine (Phila Pa 1976). 2000;25:1424–35. discussion 1435–6.

    Article  CAS  Google Scholar 

  9. Gibson JN, Waddell G. Surgery for degenerative lumbar spondylosis: updated Cochrane Review. Spine (Phila Pa 1976). 2005;30:2312–20.

    Article  Google Scholar 

  10. Javid MJ, Hadar EJ. Long-term follow-up review of patients who underwent laminectomy for lumbar stenosis: a prospective study. J Neurosurg. 1998;89:1–7.

    Article  CAS  PubMed  Google Scholar 

  11. Rampersaud YR, Ravi B, Lewis SJ, et al. Assessment of health-related quality of life after surgical treatment of focal symptomatic spinal stenosis compared with osteoarthritis of the hip or knee. Spine J. 2008;8:296–304.

    Article  PubMed  Google Scholar 

  12. Atlas SJ, Keller RB, Wu YA, et al. Long-term outcomes of surgical and nonsurgical management of lumbar spinal stenosis: 8 to 10 year results from the maine lumbar spine study. Spine (Phila Pa 1976). 2005;30:936–43.

    Article  Google Scholar 

  13. Chang Y, Singer DE, Wu YA, et al. The effect of surgical and nonsurgical treatment on longitudinal outcomes of lumbar spinal stenosis over 10 years. J Am Geriatr Soc. 2005;53:785–92.

    Article  PubMed  Google Scholar 

  14. Iguchi T, Kurihara A, Nakayama J, et al. Minimum 10-year outcome of decompressive laminectomy for degenerative lumbar spinal stenosis. Spine (Phila Pa 1976). 2000;25:1754–9.

    Article  CAS  Google Scholar 

  15. Jansson KA, Nemeth G, Granath F, et al. Spinal stenosis re-operation rate in Sweden is 11 % at 10 years – A national analysis of 9,664 operations. Eur Spine J. 2005;14:659–63.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Kornblum MB, Fischgrund JS, Herkowitz HN, et al. Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective long-term study comparing fusion and pseudarthrosis. Spine (Phila Pa 1976). 2004;29:726–33. discussion 733–4.

    Article  Google Scholar 

  17. Mirza SK, Deyo RA, Heagerty PJ, et al. Towards standardized measurement of adverse events in spine surgery: conceptual model and pilot evaluation. BMC Musculoskelet Disord. 2006;7:53.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Ratliff JK, Lebude B, Albert T, et al. Complications in spinal surgery: comparative survey of spine surgeons and patients who underwent spinal surgery. J Neurosurg Spine. 2009;10:578–84.

    Article  PubMed  Google Scholar 

  19. Nasser R, Yadla S, Maltenfort MG, et al. Complications in spine surgery. J Neurosurg Spine. 2010;13:144–57.

    Article  PubMed  Google Scholar 

  20. Schoenfeld AJ, Ochoa LM, Bader JO, et al. Risk factors for immediate postoperative complications and mortality following spine surgery: a study of 3475 patients from the National Surgical Quality Improvement Program. J Bone Joint Surg Am. 2011;93:1577–82.

    PubMed  Google Scholar 

  21. Yadla S, Malone J, Campbell PG, et al. Early complications in spine surgery and relation to preoperative diagnosis: a single-center prospective study. J Neurosurg Spine. 2010;13:360–6.

    Article  PubMed  Google Scholar 

  22. Rampersaud YR, Moro ER, Neary MA, et al. Intraoperative adverse events and related postoperative complications in spine surgery: implications for enhancing patient safety founded on evidence-based protocols. Spine (Phila Pa 1976). 2006;31:1503–10.

    Article  Google Scholar 

  23. Dekutoski MB, Norvell DC, Dettori JR, et al. Surgeon perceptions and reported complications in spine surgery. Spine (Phila Pa 1976). 2010;35:S9–21.

    Article  Google Scholar 

  24. Hess DR. Retrospective studies and chart reviews. Respir Care. 2004;49:1171–4.

    PubMed  Google Scholar 

  25. Sauerland S, Lefering R, Neugebauer EA. Retrospective clinical studies in surgery: potentials and pitfalls. J Hand Surg Br. 2002;27:117–21.

    Article  CAS  PubMed  Google Scholar 

  26. Deyo RA, Cherkin DC, Loeser JD, et al. Morbidity and mortality in association with operations on the lumbar spine. The influence of age, diagnosis, and procedure. J Bone Joint Surg Am. 1992;74:536–43.

    CAS  PubMed  Google Scholar 

  27. Wiese M, Kramer J, Bernsmann K, et al. The related outcome and complication rate in primary lumbar microscopic disc surgery depending on the surgeon’s experience: comparative studies. Spine J. 2004;4:550–6.

    Article  PubMed  Google Scholar 

  28. Williams BJ, Sansur CA, Smith JS, et al. Incidence of unintended durotomy in spine surgery based on 108,478 cases. Neurosurgery. 2011;68:117–23. discussion 123–4.

    Article  PubMed  Google Scholar 

  29. Fountas KN, Kapsalaki EZ, Nikolakakos LG, et al. Anterior cervical discectomy and fusion associated complications. Spine (Phila Pa 1976). 2007;32:2310–7.

    Article  Google Scholar 

  30. Newhouse KE, Lindsey RW, Clark CR, et al. Esophageal perforation following anterior cervical spine surgery. Spine (Phila Pa 1976). 1989;14:1051–3.

    Article  CAS  Google Scholar 

  31. Boakye M, Patil CG, Santarelli J, et al. Cervical spondylotic myelopathy: complications and outcomes after spinal fusion. Neurosurgery. 2008;62:455–61. discussion 461–2.

    Article  PubMed  Google Scholar 

  32. Shamji MF, Cook C, Pietrobon R, et al. Impact of surgical approach on complications and resource utilization of cervical spine fusion: a nationwide perspective to the surgical treatment of diffuse cervical spondylosis. Spine J. 2009;9:31–8.

    Article  PubMed  Google Scholar 

  33. Wang MC, Chan L, Maiman DJ, et al. Complications and mortality associated with cervical spine surgery for degenerative disease in the United States. Spine (Phila Pa 1976). 2007;32:342–7.

    Article  Google Scholar 

  34. Marawar S, Girardi FP, Sama AA, et al. National trends in anterior cervical fusion procedures. Spine (Phila Pa 1976). 2010;35:1454–9.

    Google Scholar 

  35. Malter AD, McNeney B, Loeser JD, et al. 5-Year reoperation rates after different types of lumbar spine surgery. Spine (Phila Pa 1976). 1998;23:814–20.

    Article  CAS  Google Scholar 

  36. Memtsoudis SG, Vougioukas VI, Ma Y, et al. Perioperative morbidity and mortality after anterior, posterior, and anterior/posterior spine fusion surgery. Spine (Phila Pa 1976). 2011;36:1867–77.

    Article  Google Scholar 

  37. Boden SD, Kang J, Sandhu H, et al. Use of recombinant human bone morphogenetic protein-2 to achieve posterolateral lumbar spine fusion in humans: a prospective, randomized clinical pilot trial: 2002 Volvo Award in clinical studies. Spine (Phila Pa 1976). 2002;27:2662–73.

    Article  Google Scholar 

  38. Boden SD, Zdeblick TA, Sandhu HS, et al. The use of rhBMP-2 in interbody fusion cages. Definitive evidence of osteoinduction in humans: a preliminary report. Spine (Phila Pa 1976). 2000;25:376–81.

    Article  CAS  Google Scholar 

  39. Cahill KS, Chi JH, Day A, et al. Prevalence, complications, and hospital charges associated with use of bone-morphogenetic proteins in spinal fusion procedures. JAMA. 2009;302:58–66.

    Article  CAS  PubMed  Google Scholar 

  40. Carragee EJ, Hurwitz EL, Weiner BK. A critical review of recombinant human bone morphogenetic protein-2 trials in spinal surgery: emerging safety concerns and lessons learned. Spine J. 2011;11:471–91.

    Article  PubMed  Google Scholar 

  41. Cook C, Tackett S, Shah A, et al. Diabetes and perioperative outcomes following cervical fusion in patients with myelopathy. Spine (Phila Pa 1976). 2008;33:E254–60.

    Article  Google Scholar 

  42. Li G, Patil CG, Lad SP, et al. Effects of age and comorbidities on complication rates and adverse outcomes after lumbar laminectomy in elderly patients. Spine (Phila Pa 1976). 2008;33:1250–5.

    Article  Google Scholar 

  43. Oldridge NB, Yuan Z, Stoll JE, et al. Lumbar spine surgery and mortality among Medicare beneficiaries, 1986. Am J Public Health. 1994;84:1292–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  44. Ciol MA, Deyo RA, Kreuter W, et al. Characteristics in Medicare beneficiaries associated with reoperation after lumbar spine surgery. Spine (Phila Pa 1976). 1994;19:1329–34.

    Article  CAS  Google Scholar 

  45. Jordan JM, Helmick CG, Renner JB, et al. Prevalence of hip symptoms and radiographic and symptomatic hip osteoarthritis in African Americans and Caucasians: the Johnston County Osteoarthritis Project. J Rheumatol. 2009;36:809–15.

    Article  PubMed Central  PubMed  Google Scholar 

  46. Jordan JM, Helmick CG, Renner JB, et al. Prevalence of knee symptoms and radiographic and symptomatic knee osteoarthritis in African Americans and Caucasians: the Johnston County Osteoarthritis Project. J Rheumatol. 2007;34:172–80.

    PubMed  Google Scholar 

  47. Hootman JM, Helmick CG. Projections of US prevalence of arthritis and associated activity limitations. Arthritis Rheum. 2006;54:226–9.

    Article  PubMed  Google Scholar 

  48. Makela KT, Eskelinen A, Pulkkinen P, et al. Total hip arthroplasty for primary osteoarthritis in patients fifty-five years of age or older. An analysis of the Finnish arthroplasty registry. J Bone Joint Surg Am. 2008;90:2160–70.

    Article  PubMed  Google Scholar 

  49. Labek G, Thaler M, Janda W, et al. Revision rates after total joint replacement: cumulative results from worldwide joint register datasets. J Bone Joint Surg Br. 2011;93:293–7.

    Article  CAS  PubMed  Google Scholar 

  50. O’Boyle CA, McGee H, Hickey A, et al. Individual quality of life in patients undergoing hip replacement. Lancet. 1992;339:1088–91.

    Article  PubMed  Google Scholar 

  51. Wiklund I, Romanus B. A comparison of quality of life before and after arthroplasty in patients who had arthrosis of the hip joint. J Bone Joint Surg Am. 1991;73:765–9.

    CAS  PubMed  Google Scholar 

  52. Memtsoudis SG, Della Valle AG, Besculides MC, et al. Trends in demographics, comorbidity profiles, in-hospital complications and mortality associated with primary knee arthroplasty. J Arthroplasty. 2009;24:518–27.

    Article  PubMed  Google Scholar 

  53. Liu SS, Della Valle AG, Besculides MC, et al. Trends in mortality, complications, and demographics for primary hip arthroplasty in the United States. Int Orthop. 2009;33:643–51.

    Article  PubMed Central  PubMed  Google Scholar 

  54. Mantilla CB, Horlocker TT, Schroeder DR, et al. Frequency of myocardial infarction, pulmonary embolism, deep venous thrombosis, and death following primary hip or knee arthroplasty. Anesthesiology. 2002;96:1140–6.

    Article  PubMed  Google Scholar 

  55. Mortazavi SM, Kakli H, Bican O, et al. Perioperative stroke after total joint arthroplasty: prevalence, predictors, and outcome. J Bone Joint Surg Am. 2010;92:2095–101.

    Article  PubMed  Google Scholar 

  56. Leung F, Richards CJ, Garbuz DS, et al. Two-stage total hip arthroplasty: how often does it control methicillin-resistant infection? Clin Orthop Relat Res. 2011;469:1009–15.

    Article  PubMed Central  PubMed  Google Scholar 

  57. Malinzak RA, Ritter MA, Berend ME, et al. Morbidly obese, diabetic, younger, and unilateral joint arthroplasty patients have elevated total joint arthroplasty infection rates. J Arthroplasty. 2009;24:84–8.

    Article  PubMed  Google Scholar 

  58. Katz JN, Losina E, Barrett J, et al. Association between hospital and surgeon procedure volume and outcomes of total hip replacement in the United States medicare population. J Bone Joint Surg Am. 2001;83-A:1622–9.

    CAS  PubMed  Google Scholar 

  59. Soohoo NF, Farng E, Lieberman JR, et al. Factors that predict short-term complication rates after total hip arthroplasty. Clin Orthop Relat Res. 2010;468:2363–71.

    Article  PubMed Central  PubMed  Google Scholar 

  60. Ritter MA, Olberding EM, Malinzak RA. Ultraviolet lighting during orthopaedic surgery and the rate of infection. J Bone Joint Surg Am. 2007;89:1935–40.

    Article  PubMed  Google Scholar 

  61. Wojkowska-Mach J, Jaje E, Romaniszyn D, et al. Comparison of SSI rates in endoarthroplasty of hip and knee in a Cracow patient population and the importance of postdischarge surveillance. Infection. 2008;36:36–40.

    Article  CAS  PubMed  Google Scholar 

  62. AlBuhairan B, Hind D, Hutchinson A. Antibiotic prophylaxis for wound infections in total joint arthroplasty: a systematic review. J Bone Joint Surg Br. 2008;90:915–9.

    Article  CAS  PubMed  Google Scholar 

  63. Harbarth S, Samore MH, Carmeli Y. Antibiotic prophylaxis and the risk of Clostridium difficile-associated diarrhoea. J Hosp Infect. 2001;48:93–7.

    Article  CAS  PubMed  Google Scholar 

  64. Jenkins PJ, Teoh K, Simpson PM, et al. Clostridium difficile in patients undergoing primary hip and knee replacement. J Bone Joint Surg Br. 2010;92:994–8.

    Article  CAS  PubMed  Google Scholar 

  65. Kurd MF, Pulido L, Joshi A, et al. Clostridium difficile infection after total joint arthroplasty: who is at risk? J Arthroplasty. 2008;23:839–42.

    Article  PubMed  Google Scholar 

  66. Parvizi J, Pawasarat IM, Azzam KA, et al. Periprosthetic joint infection: the economic impact of methicillin-resistant infections. J Arthroplasty. 2010;25:103–7.

    Article  PubMed  Google Scholar 

  67. Soong M, Rubash HE, Macaulay W. Dislocation after total hip arthroplasty. J Am Acad Orthop Surg. 2004;12:314–21.

    PubMed  Google Scholar 

  68. Woo RY, Morrey BF. Dislocations after total hip arthroplasty. J Bone Joint Surg Am. 1982;64:1295–306.

    CAS  PubMed  Google Scholar 

  69. Morrey BF. Instability after total hip arthroplasty. Orthop Clin North Am. 1992;23:237–48.

    CAS  PubMed  Google Scholar 

  70. Huddleston JI, Maloney WJ, Wang Y, et al. Adverse events after total knee arthroplasty: a national Medicare study. J Arthroplasty. 2009;24:95–100.

    Article  PubMed  Google Scholar 

  71. Heit JA, Silverstein MD, Mohr DN, et al. Predictors of survival after deep vein thrombosis and pulmonary embolism: a population-based, cohort study. Arch Intern Med. 1999;159:445–53.

    Article  CAS  PubMed  Google Scholar 

  72. Eriksson BI, Dahl OE, Rosencher N, et al. Dabigatran etexilate versus enoxaparin for prevention of venous thromboembolism after total hip replacement: a randomised, double-blind, non-inferiority trial. Lancet. 2007;370:949–56.

    Article  CAS  PubMed  Google Scholar 

  73. Schiff RL, Kahn SR, Shrier I, et al. Identifying orthopedic patients at high risk for venous thromboembolism despite thromboprophylaxis. Chest. 2005;128:3364–71.

    Article  PubMed  Google Scholar 

  74. Warwick D, Friedman RJ, Agnelli G, et al. Insufficient duration of venous thromboembolism prophylaxis after total hip or knee replacement when compared with the time course of thromboembolic events: findings from the Global Orthopaedic Registry. J Bone Joint Surg Br. 2007;89:799–807.

    Article  CAS  PubMed  Google Scholar 

  75. White RH, Romano PS, Zhou H, et al. Incidence and time course of thromboembolic outcomes following total hip or knee arthroplasty. Arch Intern Med. 1998;158:1525–31.

    Article  CAS  PubMed  Google Scholar 

  76. Lindahl H, Oden A, Garellick G, et al. The excess mortality due to periprosthetic femur fracture. A study from the Swedish national hip arthroplasty register. Bone. 2007;40:1294–8.

    Article  CAS  PubMed  Google Scholar 

  77. Beals RK, Tower SS. Periprosthetic fractures of the femur. An analysis of 93 fractures. Clin Orthop Relat Res. 1996;327:238–46.

    Article  PubMed  Google Scholar 

  78. Lewallen DG, Berry DJ. Periprosthetic fracture of the femur after total hip arthroplasty: treatment and results to date. Instr Course Lect. 1998;47:243–9.

    CAS  PubMed  Google Scholar 

  79. Lindahl H, Malchau H, Herberts P, et al. Periprosthetic femoral fractures classification and demographics of 1049 periprosthetic femoral fractures from the Swedish National Hip Arthroplasty Register. J Arthroplasty. 2005;20:857–65.

    Article  PubMed  Google Scholar 

  80. Schwartz Jr JT, Mayer JG, Engh CA. Femoral fracture during non-cemented total hip arthroplasty. J Bone Joint Surg Am. 1989;71:1135–42.

    PubMed  Google Scholar 

  81. Berry DJ. Epidemiology: hip and knee. Orthop Clin North Am. 1999;30:183–90.

    Article  CAS  PubMed  Google Scholar 

  82. Lindahl H, Garellick G, Regner H, et al. Three hundred and twenty-one periprosthetic femoral fractures. J Bone Joint Surg Am. 2006;88:1215–22.

    Article  PubMed  Google Scholar 

  83. Kim KI, Egol KA, Hozack WJ, et al. Periprosthetic fractures after total knee arthroplasties. Clin Orthop Relat Res. 2006;446:167–75.

    Article  PubMed  Google Scholar 

  84. Su ET, DeWal H, Di Cesare PE. Periprosthetic femoral fractures above total knee replacements. J Am Acad Orthop Surg. 2004;12:12–20.

    PubMed  Google Scholar 

  85. Healy WL, Siliski JM, Incavo SJ. Operative treatment of distal femoral fractures proximal to total knee replacements. J Bone Joint Surg Am. 1993;75:27–34.

    CAS  PubMed  Google Scholar 

  86. Inglis AE, Walker PS. Revision of failed knee replacements using fixed-axis hinges. J Bone Joint Surg Br. 1991;73:757–61.

    CAS  PubMed  Google Scholar 

  87. Ritter MA, Faris PM, Keating EM. Anterior femoral notching and ipsilateral supracondylar femur fracture in total knee arthroplasty. J Arthroplasty. 1988;3:185–7.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA

    Anas Saleh

  2. Clinical Orthopedic Surgery, Department of Orthopedic Surgery, Weill Cornell Medical College, and Hospital for Special Surgery, New York, NY, USA

    Charles N. Cornell

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  1. Anas Saleh
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  2. Charles N. Cornell
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Correspondence to Anas Saleh .

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Editors and Affiliations

  1. Department of Medicine, Hospital for Special Surgery, New York, New York, USA

    C. Ronald MacKenzie

  2. Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA

    Charles N. Cornell

  3. Department of Anesthesiology, Hospital for Special Surgery, New York, New York, USA

    Stavros G. Memtsoudis

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Saleh, A., Cornell, C.N. (2014). The Prevalence of Disabling Musculoskeletal Conditions and the Demand for Orthopedic Surgery in the Twenty-First Century. In: MacKenzie, C., Cornell, C., Memtsoudis, S. (eds) Perioperative Care of the Orthopedic Patient. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-0100-1_2

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