Efforts to create a joint registry continue to fail
Last year, in the U.S. alone, nearly one million knees and joints were implanted in patients. Worldwide, the U.S. is the number one manufacturer and the number one user of joint implants. Unlike other countries, however, we have no joint registry and there is no organized follow-up of implant patients. As a result, Medicare, Medicaid, private insurers and individual patients literally spend millions of dollars on defective implants that are not identified on a timely basis. Dr. Lawrence Dorr, an Orthopedic surgeon, has performed more than 5,000 hip replacements in his career, a surgery that costs $30 to 40 thousand dollars. In 2007, he noticed that many of his patients were requiring immediate replacement of their implants because of intractable pain. Then he noticed that they were all victims of the same defective device, and he informed the manufacturer, Zimmmer Holdings. Zimmer responded that Dorr's technique was to blame and continued to sell the device until July of 2008, when it took the device off the market. (After Dorr consulted with colleagues and found that his experience was not at all uncommon.)
The New York Times reported that Dorr had similarly alerted consumers and physicians to a defective device eight years ago, when implants manufactured by Sulzer Orthopedics were contaminated with oil and more than 3000 required replacement. Sweden has an implant registry which identified the problem more promptly and only 30 patients received the Sulzer hip (before the company went bankrupt). A number of other countries utilize such registries and Kaiser Permanente also saves money by maintaining this data.
According to the Times, Dr. Wiliam Jiranek has attempted for years to create a public registry in Virginia. Unfortunately, his efforts have been unavailing, in part due to lack of governmental resources, and in part due to lack of cooperation from doctors and manufacturers. A registry requires follow-up paperwork by doctors, and the documentation of unsuccessful surgery. Furthermore, many implant surgeons are paid substantial "consulting" fees for using a particular implant and are subject to the potential for a conflict of interest: last year device manufacturers paid $310 million dollars in fines to resolve a Department of Justice investigation into whether they had paid illegal inducements to doctors to persuade them to use their devices.
Of course, maintenance of such a database is expensive. While it would save money in the long-term, Medicare and other government programs supervised by politicians rarely take such a long-term view toward this kind of issue. And consulting fees paid to doctors who utilize a particular implant appear to be more an inducement to buy than compensation for genuine feedback on performance of the device.