Spend our treasured well being care {dollars} correctly
March 10, 2025
5 min learn
Frederick A. Matsen III, MD, one of many world’s main specialists in shoulder and elbow surgical procedure, brings greater than 5 many years of expertise to his Visitor Commentary.
Famend for pioneering methods he developed on the College of Washington, such because the “ream-and-run” process, in depth capsular releases, open Bankart repairs and the Easy Shoulder Check, his insights are extremely valued by those that handle shoulder and elbow circumstances. His management, together with greater than 20 years as chair of the division, positions him as a reputable voice in all areas of orthopedic surgical procedure, particularly on matters like cost-effectiveness and innovation, that are central to this Visitor Commentary.
Picture: Frederick A. Matsen III, MD
Matsen advocates for using the very best methods and applied sciences to reinforce affected person consolation and performance with out incurring pointless prices. Importantly, new know-how doesn’t routinely represent an enchancment if outcomes are missing or don’t match these of historic procedures. This strategy aligns with value-based care, guaranteeing that prices are justified primarily by improved outcomes.
Anthony A. Romeo
Matsen discusses that every technological innovation brings further prices, similar to analysis, growth, guide charges, advertising, studying curves, remembers and issues, which are sometimes missed by orthopedic surgeons and regularly launched with out thorough medical end result research. Moreover, FDA-cleared applied sciences don’t assure effectiveness, security or improved outcomes, highlighting the necessity for rigorous medical evaluations after new know-how is built-in into the orthopedic care mannequin.
As well being care supply shifts away from a fee-for-service mannequin to a value-based care mannequin, orthopedic surgeons will considerably affect the price of care whereas being accountable for the standard and outcomes of care, which can or is probably not enhanced by the most recent know-how.
– Anthony A. Romeo, MD
Chief Medical Editor, Healio | Orthopedics Immediately
Orthopedic surgical procedure is a fabulous area as a result of we will make significant enhancements within the consolation and performance of sufferers disabled by arthritis, instability, tendon tears, developmental issues and fractures.
As orthopedic surgeons, we’re by our very nature progressive and inventive. We’re engaged in a relentless seek for simpler and safer technique of treating the sufferers who put their belief in us.
‘Inexperienced orthopedics’
The time period “inexperienced orthopedics” is used to point the considerate utility of methods and applied sciences that enhance the consolation and performance of our sufferers with out incurring pointless prices. This idea is especially vital right now when there’s an exponential enhance in costly applied sciences, a lot of which haven’t been demonstrated to enhance affected person outcomes.
The actual fact is that as orthopedic surgeons we now have energy over a considerable portion of the well being care price range of the US as a result of we deal with numerous sufferers, and our surgical remedies are costly. However from the Spider-Man comics and associated media, we study that “… with nice energy comes nice accountability.”
Frederick A. Matsen III
Utilizing my area of shoulder surgical procedure for instance, over the last a number of many years, there was a digital explosion within the methods and applied sciences for rotator cuff surgical procedure, similar to new restore methods, platelet-derived progress components, bone marrow extracts, scaffolds, patch augmentation, subacromial balloons, tendon transfers and superior capsular reconstruction. But the proof that these approaches have considerably improved the medical outcomes (ie, affected person self-assessed consolation and performance) appears missing.
Equally, within the area of shoulder arthroplasty there was a dramatic enhance within the methods and applied sciences cleared by the FDA by means of the 510(okay) course of (which solely requires that the brand new gadget is “considerably equal” to a beforehand marketed gadget, moderately than demonstrating its security and efficacy). But proof that these improvements have led to clinically important enhancements in sufferers’ consolation and performance is, once more, missing.
Every technological innovation carries with it elevated prices associated to analysis, growth, guide charges, advertising, particular person surgeon studying curves, remembers and unanticipated issues. For instance, it seems that the growing use of 3D CT-based planning could also be driving the elevated use of costlier applied sciences for managing glenoid retroversion, similar to particular glenoid elements and the usage of reverse moderately than anatomic shoulder arthroplasty. But current publications counsel postoperative glenoid retroversion doesn’t have a significant impact on the medical outcomes of shoulder arthroplasty. The out there proof signifies that the surgeon’s method in reaching wonderful seating of the glenoid part is crucial factor.
Be the very best stewards
In conclusion, it’s sure that new applied sciences will come to the market place every month. We acknowledge that FDA “clearance” doesn’t guarantee both the effectiveness or the security of those improvements.
Thus, it appears applicable that we ask the advocates of those new orthopedic improvements to show that the increment in price yields a commensurate enhance within the high quality of the result realized by the affected person. On this approach, we will be the very best stewards of the well being care bills which can be beneath our management.
References:
Collins D, et al. J Bone Joint Surg Am. 1992;74:501-507.
Congress of the US. Know-how change and the expansion of well being care spending. A Congressional Price range Workplace (CBO) Paper 2008; https://www.cbo.gov/websites/default/information/A hundred and tenth-congress-2007-2008/stories/01-31-techhealth.pdf. Accessed: Feb. 18, 2025.
Dekker TJ, et al. JSES Int. 2022;doi:10.1016/j.jseint.2022.02.011.
Grantham WJ, et al. JSES Int. 2020;doi:10.1016/j.jseint.2020.04.006.
Gutman MJ, et al. J Shoulder Elbow Surg. 2023;doi:10.1016/j.jse.2022.12.004.
Harold RE, et al. J Shoulder Elbow Surg. 2023;doi:10.1016/j.jse.2022.12.019.
Ho JC, et al. J Bone Joint Surg Am. 2013;doi:10.2106/jbjs.L.00336.
Lazarus MD, et al. J Bone Joint Surg Am. 2002;doi:10.2106/00004623-200207000-00013.
Lee S. Spider-Man from Wonderful Fantasy #15. In: Marvels Masterworks Useful resource Web page. http://www.marvelmasterworks.com/marvel/mm/spidey/amfan015.html; August 1962. Accessed: Feb. 18, 2025.
Lenzer J. Are implanted medical gadgets making a ‘hazard inside us?’. In: Davies D, NPR Recent Air. https://www.npr.org/2018/01/17/578562873/are-implanted-medical-devices-creating-a-danger-within-us. Accessed: Feb. 18, 2025.
Ma CB, et al. JSES Int. 2020;doi:10.1016/j.jseint.2020.04.009.
Matsen FA, third, et al. JBJS Open Entry. 2020;doi:10.2106/jbjs.Oa.20.00002.
McElvany MD, et al. Am J Sports activities Med. 2015;doi:10.1177/0363546514529644.
Rutledge JC, et al. J Shoulder Elbow Surg. 2024;doi:10.1016/j.jse.2023.10.031.
Schiffman CJ, et al. J Bone Joint Surg Am. 2021;doi:10.2106/jbjs.20.01853.
Service BC, et al. Clin Orthop Relat Res. 2017;doi:10.1007/s11999-017-5433-3.
Sheth MM, et al. J Shoulder Elbow Surg. 2024;doi:10.1016/j.jse.2024.04.026.
Somerson JS, et al. J Shoulder Elbow Surg. 2018;doi:10.1016/j.jse.2018.03.025.
Somerson JS, et al. J Shoulder Elbow Surg. 2019;doi:10.1016/j.jse.2018.08.043.
Somerson JS, et al. Int Orthop. 2017;doi:10.1007/s00264-017-3443-0.
U.S. Meals and Drug Administration. Class 2 gadget recall Synthes Radial Head Prosthesis System. https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfRes/res.cfm?ID=152471; Accessed: Feb. 18, 2025.
U.S. Meals and Drug Administration. Zimmer Biomet CPT Hip System Femoral Stem and elevated danger of thigh bone fracture FDA Security Communication. https://www.fda.gov/medical-devices/safety-communications/zimmer-biomet-cpt-hip-system-femoral-stem-and-increased-risk-thigh-bone-fracture-fda-safety#:~:textual content=Onpercent20Julypercent202percent2Cpercent202024percent2Cpercent20Zimmer,thepercent20devicepercent20bypercent20Decemberpercent202024. Accessed: Feb. 18, 2025.
For extra data:
Frederick A. Matsen III, MD, is a professor, division of orthopaedic surgical procedure and sports activities drugs, College of Washington Medical Heart. He will be reached at matsen@uw.edu.
Sources/Disclosures
Collapse
Disclosures:
Matsen stories receiving assist for this research from the College of Washington’s Douglas T. Harryman II/Depuy Endowed Chair for Shoulder Analysis and The Rick and Anne Matsen Endowed Professorship for Shoulder Analysis.
