Thursday, 28 July 2011

Orthopedic boys like newer toys!!.

Having worked in the UK for a few years and believing in the old school of thought that newer technology/implants should only replace the time tested ones only after rigrous evidence of their advantage over older techniques is documented in the orthopedic literature, I have realised that in Delhi NCR area, a significant chunk of Orthopedic Surgeons are eager to jump on the the bandwagon of a newer, more advanced, fashionable  and of course, more expensive implants as soon as they are launched in the market. Many a times these so called newer more expensive  implants are used even if they are not clinically indicated. The whole idea behind this is to prove (to oneself and your colleagues) that one is producing the better results using the latest technology and in many instances coercing/impressing patients by demonstrating that his clinical acumen and skills are better than the doctor next door who recomended "old obsolete implants" or "1st Generation implants" . I have found that in majority of these patients either these newer implants are not indicated or there is not enough data in the literature to prover the superiority of these newer implants. I have observed this most common especially in the treatment of fractures where locking plates are used in simple transverse fractres even in perfectly healthy young individuals with goood quality bones. These plates were found to be better for fixation of fractures in patients with osteoporosis and sometimes in patients with comminuted(shattred fractures in multiple pieces) fractures near the joints. However these plates have also been used exensively to treat simpler forearm fractures in healthy individuals who were being treated perfectly well for many decades with DCPs and LCDCPs, which cost 50-75% less as compared to these locking plates.

Bigger the hospital, more expensive the implants that is likely to be used in the patients. Although I an saying this purely based on my experience of seeing patients in my OPD for last 3 years, but I am sure this can be substiantiated by the data from the insurance companies(if it has not already been done by them!!). 
It is the patient who ends up footing the bill for bragging rights and boosting the ego of the operating surgeon either at the time of discharge directly or at the time of paying the insurance premiums indirectly.