Dramatic growth of hip replacements has implications for imaging centers

The European Congress of Radiology's decision to schedule a special focus session on imaging of the elderly early on Sunday morning was a bold move. Numerous receptions and dinners are held on the Saturday evening of ECR week, and some observers may have doubted delegates' willingness to arrive at the Austria Center by 8:30 a.m. to hear lectures on aging and dementia, dyspnea, and abdominal pain in the elderly.

Such doubts were unfounded, however. A healthy turnout confirmed a genuine interest in the subject. It appears that growing numbers of radiologists recognize the logistical and interpretation problems involved in examinations of the elderly. Overall, doctors seem increasingly aware that older patients behave and react differently from younger ones and are more prone to infection, fractures, and neurologic diseases.

A brief look at the statistics suggests that radiology departments of the future will no doubt accord more attention and study to the hip. The value of the European market for hip and knee replacements will rise from US$1.4 billion in 2004 to US$1.83 billion in 2010, according to consultants Frost & Sullivan. Total hip replacements (THRs) are expected to increase by 40% over the next 30 years, and the number of THRs in men older than 85 appears likely to double.

The American Academy of Orthopaedic Surgeons estimates that about 168,000 THRs are performed annually in the U.S., and by 2020, around one in every 10 North Americans will be affected by osteoarthritis, making it the most frequent cause of disability in the U.S. Unfortunately, most European countries are catching up quickly. More than 36,000 procedures are performed every year in Germany, and a total of about 80,000 are done in Italy, France, and the U.K.

Frost & Sullivan reports a 12% to 15% annual growth rate over the past few years for revision implant products. Furthermore, medical robotics, computer-assisted surgery (including image-guided techniques), minimally invasive joint replacement surgery, and bioengineered technologies are advancing rapidly.

This broad picture signals an urgent need for well-equipped imaging centers and better informed radiologists and radiographers. According to the authors of the cover story in this issue ("X-ray plays vital role in hip replacement surgery," page 14), detection and awareness of potential hip problems are essential. The high success rate of hip replacements is prompting surgeons to operate on growing numbers of younger people, many of whom wish to resume an active lifestyle. This increased activity may lead to eventual loosening of the joint replacement, requiring follow-up imaging and surgery.

I hope you enjoy our continued coverage from ECR 2005, particularly the conference reporter distributed with this edition. Please send comments or observations to me at our new e-mail address, di-europe@btconnect.com.