There are over 91,000 knee replacements carried out in the UK every year plus 1,100 repeat operations at a cost of £10k per operation. There is no objective outcome measure to ensure that the operation worked and the patient has made a full recovery. 98% knee replacements are due to osteoarthritis.
In England and Wales there are approximately 86,000 total hip replacement procedures performed each year. 92% of hip replacements are due to osteoarthritis
In the USA there are 719,000 total knee replacements and 332,000 total hip replacements.
Knee and hip replacement surgeries are becoming more common among aging Americans, with more than 7 million currently living with these artificial joints. That number is on the rise, with knee replacements increasing at a rate of 8% each year and having doubled in the last decade. Also the age range has changed downwards significantly over the past 20 years.
ACL (Anterior Cruciate Ligament)
A 150,000 ACL injuries occur in the USA each year (ref: American Orthopaedic Society for Sports Medicine 2008). Recent research has been undertaken looking in to gait asymmetries post anterior cruciate ligament reconstruction. These altered movement patterns have been linked to the development of Osteoarthritis and as a risk factor for future injury. Therefore if these issues are not addressed, an increased risk of injury, knee re-injury and long term joint health could all be a consequence. Therefore this suggests that using time based criteria that are commonly used may not be appropriate as one year post injury these gait asymmetries persist.
White et al (Anterior cruciate ligament- specialized post-operative return to sports (ACL-SPORTS) training: a randomized control trial, 2013) found that all subjects had gait asymmetries one year after reconstruction. Athletes who had hip and knee multi-plane biomechanical asymmetries present at return to play were three times more likely to incur a second ACL injury within the next year, compared to those without (Paterno et al., Biomechanical measures during landing and postural stability predict second anterior cruciate ligament injury after anterior cruciate ligament reconstruction and return to sport. 2010).
A fall is defined as an unintentional/unexpected loss of balance resulting in coming to rest on the floor, the ground, or an object below knee level.
The incidence of hip fractures in the UK is 86,000 per year, and 95% of these are the result of a fall. The cost to the UK NHS is £1.7 billion a year.
Age UK state, “Up to one in three over 65’s, or 3.4 million people suffer a fall that can cause serious injury and even death each year in the UK, costing the NHS an estimated £6m a day.” That equates to 9,315 fallers per day, (ref; Age UK, Stop Falling Report)
Injuries due to falls claim over 235,000 lives of EU citizens annually and represent the fourth leading cause of death within the European Union. Many of these falls are related to gait disorders, Ref (European code Against Injuries (ECAI), 2008)
For the individual, a fall can cause distress, pain, injury, loss of confidence and loss of independence. After a fall, 48% of older people report a fear of falling and 25% have a functional decline (NHS, 2007). These complications often lead to long-term care with costly community services and or institutional care which is funded by the state.