Welcome to the Centre for Research Excellence in Total Joint Replacement - OPUS
The Centre for Research Excellence for OPtimising oUtcomes, equity, cost effectiveness and patient Selection (OPUS) in Total Joint Replacement will transform the research and practice landscape of joint replacement surgery, and promote critically needed stewardship to optimise management for better outcomes and reduced costs for this high volume and expensive procedure.
OPUS draws together Australian and international experts in clinical care, health economics, outcomes modelling, and implementation research to address unprecedented demand for the procedure (100,000/yr and rising), burgeoning costs ($4.5 billion/yr) and unresolved dissatisfaction (up to 1 in 3 patients). Linked closely with the patient journey, 4 streams of research:
- Prognostic factors and outcomes modelling;
- Shared decision making
- Non-surgical therapies
- Hospital services coordinated care, minimising waste, complications, and uncontrolled rises in costs.
- Promotion of effective transfer of research outcomes into health policy and/or practice
These streams will focus on appropriate patient selection, informed consent, multidimensional cognitive therapies, and enhanced recovery care programs, respectively. Patient-centric safety and quality data, augmented by robust economic analysis, will underpin policy decisions, drive practice change and improve cost-effective, efficient and safe joint replacement surgery. Drawing on the experience and expertise of this multidisciplinary Research Team, dissemination, translation and implementation will be achieved through engagement of a scientific advisory council, annual stakeholder workshops, practical tools to aid community and specialist practitioners, and health professional training.
Capacity building will be realized through funding PhD scholarships and post-doctoral fellowships in this priority area, developing mentorship pathways for the future leaders, informing and influencing surgeon training, and developing and delivering training materials for professional capacity building Australia-wide. OPUS will engage a national team of research collaborators by providing a coordination and integration hub that will target and leverage all levels of NHMRC, ARC and NGO investment in musculoskeletal research. Through its unique and highly innovative approaches, OPUS will have a significant global impact by informing iterations of existing and future models of osteoarthritis care.
Read on or jump ahead using the following links.
Scope of the problem
Osteoarthritis – A leading contributor to the Global Burden of Disease.
Half of all Australians over 65 years are affected by osteoarthritis (OA) of the knee and hip. OA, which is the largest contributor to the global burden of musculoskeletal (MSK) disorders, has the sharpest upward trajectory across the MSK conditions (58% increase in the next 2 decades). With musculoskeletal (21.3%) rivalling mental and behavioural (22.7%) disorders for the greatest proportion of years lost through disability, the Global Burden of Disease Study has identified the former as one of the top three priorities that require urgent policy responses.
The place of Total Joint Replacement.
Current guidelines recommend non-surgical interventions for the majority of people with OA. In a proportion, however, OA progresses to a point where these interventions are considered ineffective and total joint replacement (TJR) becomes the only option to improve their quality of life.
What are the key issues in Total Joint Replacement?
Although TJR has revolutionized the treatment of patients crippled by end-stage OA and has been referred to as the operation of the century there is growing concern related to cost, demand and dissatisfaction that compels a reassessment of how TJR should be best deployed.
TJR is a highly cost-effective procedure for treating end-stage OA. Alarming increases in incremental and total costs of this procedure as well as projected rises in disease burden have raised considerable concern about the sustainability of current practices. In the Australian private sector alone in 2013, the direct cost of total knee and hip TJR was $414 million and $522 million respectively. These represent a rise in cost of 20% and 25%, respectively from the previous year.
Unnecessary surgery can harm patients and adds cost for the nation
It is also estimated that one quarter of TJRs are performed in inappropriate candidates at an average cost of $21k per procedure (CI-A, G, H), suggesting that up to $284 million of healthcare expenditure may be attributed to overuse of TJR each year in Australia. Moreover, post-operative complications add a further 18% of direct hospital costs ($210 million) in the first 30 days following TJR (CI-A, G, H). The total direct cost of joint replacement surgery (public and private) in Australia in 2013 approximated $1.5 billion dollars. If indirect costs are estimated to be twice the direct costs, then the combined cost (direct and indirect) of treating end-stage OA with TJR is almost $4.5 billion. This represents almost 10% of all hospital costs ($55.9 billion) in Australia for the same period.
In 2014, almost 100,000 Australians received TJRs, representing an increase of 45% in hip and 77% in knee procedures since the first year of complete national TJR data collection in 2003. The annual number of TJRs is expected to double by 2030. This is consistent with overseas trends where TJR is projected to rise between 300-600% in the United States by 2030.
This may reflect lack of alignment of patient perception and operator expectations. The costs are high and can be reduced. Approximately 15-30% of patients remain dissatisfied following TJR, even in the absence of acute complications such as infection (CI-A, G). Recent research indicates that the majority of patients undergoing surgical interventions overestimate the expected benefit and underestimate the harm and it is this imbalance that leads to dissatisfaction levels as high as 49% in TJR recipients compared to 6% in those whose expectations have been met. Patients regard this as a ‘poor outcome’, which leads many to seek ongoing care including implant revision of the implant or non-surgical therapies. This dissatisfaction is estimated to cost Australia $405 million from unbeneficial surgery in 2014.
The Centre for Research Excellence in Total Joint Replacement (OPUS) comprises of a variety of clinical, social and surgically related academic and industry related staff.
To find out more, click on the following links:
The University of Melbourne
La Trobe University
Queensland University of Technology
The University of South Australia
St Vincent's Hospital Australia
Aspectar Hospital Qatar
Australian Orthopedic Assoc
NHMRC Centre for Research Excellence - APP1116325