Musculoskeletal diseases and injuries have an enormous socio-economic impact. With a proportion of 16% (35.7 billion €) of the total direct medical costs (€ 223.6 billion) in Germany´s Public Health Care System, they rank first together with cardiovascular diseases. They also cause more than 40% of all lost work days, 42% of all rehabilitation services and 25% of all early retirement in Germany. Due to the demographic development, despite declining population figures the number of patients will steadily increase. Germany is forecast for a rise in hospital discharges throughout all diagnoses by 12 % from 2005 to 2020.
In the musculoskeletal area we expect even higher numbers. US-American studies assume that by time the following cases will be doubled when compared to 2005
- femoral neck fractures by 2050
- primary implantation of hip prostheses by 2026
- primary implantation of knee prostheses by 2016
In 2030 the percentage of hip revisions for hip arthroplasty will amount to 17%, in case of knee arthroplasty will be 9%.
Spinal fusion is predicted to increase 7-fold in the cervical spine and up to 19-fold at the lumbar spine by 2030. Tumor surgery will increase around 40% by 2030 if the incidence of new cases remains stable.
In view of such impressive numbers and taking into account the fact that we face a serious lack of young academics the question arises, who will operate on these patients and what the costs will be.
We will be well advised to care for new interdisciplinary structures and networks which allow for more efficiency and efficacy of our limited resources.
In cases where surgery fails to further alleviate musculoskeletal conditions, conservative strategies and psychsocial support may be an important and succesful alternative. Established complex multidisciplinary treatment strategies in primary, secondary and tertiary prevention must be implemented consistently. There is still a huge need for research in basic and clinical science and also particularly in health services and rehabilitation.