implants. In the case of augmentation breast surgery following
mastectomy, the line is blurred between augmentation and restoration.
In fact, the lines are often blurred among categories. For instance, a
cochlear implant is used to restore hearing among the deaf, but is this
restoration or substitution? When a cardiac stent is precisely snaked into a
coronary artery, is this repair or restoration? Whatever the case, implants
powerfully facilitate healing at the hands of physicians and surgeons. As
Francis Bacon dreamed four hundred years ago, “Let us hope ... there may
spring helps to man, and a line and race of inventions that may in some
degree subdue and overcome the necessities and miseries of humanity.”
Here, then, is a computation of the lines of invention.
Orthopedic surgeons facilitate the implantation of more devices than
any other specialty. Joint arthroplasty of shoulders, elbows, wrists, fingers,
hips, knees, ankles, and toes, combined with spinal fusion, fracture
management, and tendon and ligament repair result in millions of
operations every year in America. Prior to Smith-Petersen’s cup
arthroplasty in Boston in 1938, almost no implantation of metal occurred
in America, and for another decade, a slow uptick in the rate of
implantation occurred. During the 1950s, orthopedic surgeons in America,
Europe, and Japan began pioneering joint arthroplasty, and by the 1960s
the revolution was in full bloom.
JOINT REPLACEMENTAs discussed elsewhere in this book, there is no US joint registry, so
appraisals about joint replacements are based upon commercial and
governmental estimates. The most reliable estimates are contained in the
National Inpatient Sample (NIS), the “largest all-payer inpatient care
database in the United States, containing data on more than seven million
hospital stays.”^4 NIS is the largest database compiled by the Healthcare
Cost and Utilization Project (HCUP), and is sponsored by the Agency for
Healthcare Research and Quality (AHRQ), itself a part of the US
Department of Health and Human Services (HHS), with a tiny budget
compared to other divisions like the NIH, CDC, CMS, and FDA.
Information in the NIS captures about 20 perent of all hospital discharges,