Total joint replacement (TJR) is one of the most commonly performed surgical procedure in the United States, and the volume of primary and revision total joint replacement procedures have increased consistently in past decade. New research presented at the 2018 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS) analyzed models to predict the future volume of total joint arthroplasty (TJR) procedures in the United States of America.
Total hip (THR) and total knee replacement (TKR) are proven to improve symptoms and function in patients with arthritis. According to data from the National Inpatient Sample, in 2014 there were 370,770 total hip replacements and 680,150 total knee replacements.
Based on the linear regression model, this study showed that, overall, the volume of primary and revision total joint replacement is significantly lower than studies that have used exponential growth. Subpopulation prevalence was combined with census projects to predict national procedure volume for 2030 to 2060, followed by a pairwise correlation to assess consistency among models. As a result, these data findings can help guide healthcare economic policy and allocation of future resources to optimize the delivery of patient care.
“We were particularly interested in the predictions for TJR as the projected volume of procedures by 2030 and 2060 were very high,” said Matthew Sloan, MD, orthopaedic resident at the University of Pennsylvania and lead author of the study. “We went into our study thinking that the previously anticipated exponential growth among these procedures was not consistent with current trends, and it might be an overestimate.”
This study’s findings show that by 2030, primary total hip replacement (THR) is projected to grow 171 percent, and primary total knee replacement (TKR) is expected to increase by up to 189 percent, for a projected 635,000 and 1.28 million procedures, respectively. Revision joint replacement is also expected to increase by 142% for hips (72,000) and 190% for Knees (120,000). By 2060, primary THR is expected to reach 1.23 million (330 percent increase), primary TKR is expected to reach 2.60 million (382 percent increase), revision THR is expected to reach 110,000 (219 percent increase), and revision TKR is expected to reach 253,000 (400 percent increase).
“These numbers are always changing,” noted Dr. Sloan. “We will continue to look at new data as the numbers need to be constantly updated, especially if they are used to make predictions for future healthcare saving decisions, as the impact can be in the millions of dollars. It’s imperative to provide policymakers with high-quality data to inform decisions that will affect patient access to orthopaedic care and the financial viability of elective orthopedic procedures.”
In related research also presented at the meeting, Dr. Sloan and his team looked at the changing demographics in total joint arthroplasty in the U.S. from 2000 to 2014. They found that more younger patients are getting joint replacements compared to past. The mean age for a primary total hip replacement has declined from 66.3 years to 64.9 and total knee replacement from 68 years to 65.9. Gender wise females continue to make up the majority of patients at 55-62%. Non-Hispanic whites comprise 80-86% of the total joint replacement population followed by blacks (8-11%), Hispanics (3-6%) and Asians (less than 1%). The proportion of Non-Hispanic whites has been decreasing over time as the proportion of blacks has increased with the minimal change in the percentage of Asians and Hispanics undergoing total joint replacement procedures.
Adapted from press release by Americal Association of Orthopaedic Surgeons.
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