Sculco Thomas P
Hospital for Special Surgery, New York, New York, USA.
Orthopedics. 2010 Sep 7;33(9):628. doi: 10.3928/01477447-20100722-46.
New technology in joint replacement design and materials adds cost that must be documented by improved outcomes. This is not always the case as the recent metal/metal data has shown. The current economics of arthroplasty have put increasing financial pressure on hospitals and will progress under new health care legislation. New technology must be cost-effective and this will be increasingly difficult in an era of outstanding long-term results with current designs. Cost may necessitate less expensive alternatives, eg, generic implants, in arthroplasty patients. Joint replacement surgery has evolved over the past 4 decades into a highly successful surgical procedure. Earlier designs and materials that demonstrated inferior functional and long-term results have disappeared in a Darwinian fashion. Through this evolutionary process many of the current designs have proven efficacy and durability. Current outcome data indicates that hip and knee designs demonstrate 90% to 95% success rates at 15-year follow-up. Technologic advances are necessary to improve implant design and materials, however, only in an environment of reduced reimbursement to hospitals can the increase cost be justified.
关节置换设计与材料方面的新技术增加了成本，而这必须通过改善治疗效果来证明其合理性。正如最近金属对金属的数据所显示的那样，情况并非总是如此。目前关节成形术的经济状况给医院带来了越来越大的财务压力，并且在新的医疗保健立法下这种压力还会加剧。新技术必须具有成本效益，而在当前设计取得出色长期效果的时代，做到这一点将越来越困难。成本可能促使人们在关节置换患者中选择较便宜的替代品，例如普通植入物。在过去40年里，关节置换手术已发展成为一种非常成功的外科手术。早期那些功能和长期效果较差的设计与材料已以达尔文式的方式被淘汰。通过这一进化过程，许多当前的设计已证明其有效性和耐用性。目前的治疗效果数据表明，髋部和膝部置换设计在15年随访时成功率为90%至95%。技术进步对于改进植入物设计和材料是必要的，然而，只有在医院报销费用减少的环境下，成本增加才是合理的。
