The rising tide of orthopaedic surgery across the Middle East

The demand for orthopaedic surgery is increasing around the world. As the global population continues to age, more people require surgical intervention to alleviate chronic pain, especially those with hip or knee joint conditions.

In 1950, the global average life expectancy was 47 years; now it is more than 73 years. The total population of people aged 65 or over across the Middle East has almost doubled in the last two decades, rising from 13.7 million in 2000 to more than 25.2 million in 2022.

During this time hip replacement rates increased by 30 percent between 2007 and 2017 across OECD countries, and this trend is beginning to be reflected across the Middle East. In Turkey, there were 60 total hip replacement (THR) surgeries for every 100,000 people in 2019 – more than double
the figure from 2010. While in Saudi Arabia, where THR surgeries are less common,
the rate of total knee arthroplasty (TKA) surgeries has increased annually.

A balancing act
Balancing increasing surgical demand and rising healthcare costs with a growing ageing population is putting healthcare systems under immense pressure – especially as many institutions are still recovering from difficulties arising from the Covid-19 pandemic. During the last two years, stopping the spread of coronavirus was prioritised over routine surgeries, causing the postponement of non-urgent operations with the aim of increasing bed capacity and protecting clinicians, patients, and nursing staff. Surgical demands are now higher post-pandemic due to the significant disruption in healthcare delivery.

As surgical demand increases the cost per procedure is likely to also increase, particularly post-pandemic. Healthcare systems across the region are now in a position where demand outweighs supply, driving costs up. Orthopaedic surgery is already costly – in 2019 hip replacements typically cost US$36,000 in Israel, while in 2017 in the United Arab Emirates, hospital admission costs for hip replacements were $22,500.

Surgical interventions
Surgery is usually the last resort for patients with joint conditions. Healthcare professionals (HCPs) first recommend other solutions, such as physiotherapy and steroid injections. However, for older patients with already limited mobility physiotherapy is not always a viable option.

THR surgery is recommended to patients with long term forms of arthritis, including osteoarthritis, rheumatoid arthritis, and septic arthritis. Patients with hip fractures are also recommended THR surgery. For those in need of surgery, delayed surgical intervention can cause a deterioration in physical and mental health. Patients awaiting orthopaedic surgery are required to live with worn or damaged joints, reduced mobility, and ongoing pain
– even while resting.

Faster recovery
Hip replacement surgeries are typically a speedy medical procedure, taking between one and two hours, however recovery can take up to five days. Despite advancements in surgery thus far, post-operative complications and re-admission rates have remained level, and some issues still exist for patients’ post-surgery. Pain, dizziness, and weakness have been reported to delay discharge following THR, as well as post-operative oedema which can be a cause of pain and loss of muscle function. Oedema has also been reported to be the main cause of hospital readmissions in the 90- day period post-surgery.

Traditional methods for treating oedema following total hip replacement surgery typically include the use of compression stockings to reduce swelling and prevent deep vein thrombosis (DVT). However, compression stockings have been linked to discomfort and are difficult to apply. HCPs across the region are now turning to innovation for new solutions to enhance recovery and reduce post-operative complications.

Breeding innovation
Implementing innovative solutions in healthcare is challenging. Healthcare systems need to ensure they can introduce new ideas that can help improve care, without negatively impacting the systems that are already in place.

It is important that new treatment plans can balance making healthcare more efficient and cost-effective, while maintaining and improving patient outcomes. Wearable devices that can aid recovery offer a unique solution that can address these issues and reduce recovery times.

Reducing post-operative oedema, for example, can enhance patient outcomes following THR surgery. Neuromuscular electrical stimulation devices can gently stimulate the common peroneal nerve activating the calf and foot muscle pumps, resulting in increased blood flow in the deep veins of the calf equal to 60 percent of walking without a patient having to move. This enhanced blood flow reduces oedema and has been clinically proven to reduce the build-up of swelling following hip replacement surgery. Wearable devices are also typically non-invasive and easier to administer than compression stockings, and reported as well tolerated.

Innovations in wearable devices have the potential to transform recovery post-surgery, both immediately after and in long term recovery. If healthcare systems can cut down inpatient care and reduce the number of readmissions post orthopaedic surgery, more resources and time will be
available to spend elsewhere.

A brighter future
Healthcare institutions across the Middle East that invest in innovation will have a bright future, despite the burden placed on them by Covid-19. Medical innovations that would have otherwise taken years to implement into care pathways are now proven to enhance healthcare delivery and are regularly being adopted into treatment plans – supporting HCPs and patients across the region by improving outcomes following surgery.

But the speed of innovation adoption must not slow. The momentum developed in the last two years can be a springboard to greater investment and innovation in healthcare and, ultimately, a brighter future for people across the region.