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. 2020 Jun;35(6S):S79-S85.
doi: 10.1016/j.arth.2020.02.030. Epub 2020 Feb 19.

Projections and Epidemiology of Revision Hip and Knee Arthroplasty in the United States to 2030

Andrew M Schwartz  1 , Kevin X Farley  2 , George N Guild  1 , Thomas L Bradbury Jr  1
Affiliations

Projections and Epidemiology of Revision Hip and Knee Arthroplasty in the United States to 2030

Andrew M Schwartz et al. J Arthroplasty. 2020 Jun.

Abstract

Background: As the incidence of primary total joint arthroplasty rises in the United States, it is important to investigate how this will impact rates of revision arthroplasty. The purpose of this study was to analyze the incidence and future projections of revision total hip arthroplasty (rTHA) and revision total knee arthroplasty (rTKA) to 2030. Anticipating surgical volume will aid surgeons in designing protocols to efficiently and effectively perform rTHA/rTKA.

Methods: The national inpatient sample was queried from 2002 to 2014 for all rTHA/rTKA. Using previously validated measures, Poisson and linear regression analyses were performed to project annual incidence of rTHA/rTKA to 2030, with subgroup analyses on modes of failure and age.

Results: In 2014, there were 50,220 rTHAs and 72,100 rTKAs. From 2014 to 2030, rTHA incidence is projected to increase by between 43% and 70%, whereas rTKA incidence is projected to increase by between 78% and 182%. The 55-64 and 65-74 age groups increased in revision incidence during the study period, whereas 75-84 age group decreased in incidence. For rTKA, infection and aseptic loosening are the 2 most common modes of failure, whereas periprosthetic fracture and infection are most common for rTHA.

Conclusion: The incidence of rTHA/rTKA is projected to increase, particularly in young patients and for infection. Given the known risk factor profiles and advanced costs associated with revision arthroplasty, our projections should encourage institutions to generate revision-specific protocols to promote safe pathways for cost-effective care that is commensurate with current value-based health care trends.

Level of evidence: IV.

Keywords: incidence; infection; projections; revision hip arthroplasty; revision knee arthroplasty.

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Conflict of interest statement

One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2020.02.030.

Figures

Fig. 1.
Fig. 1.
(A) Projections of revision total hip arthroplasty to 2030. (B) Projections of revision total knee arthroplasty to 2030. Error bars are 95% confidence interval.
Fig 2.
Fig 2.
(A) Projections of revision total hip arthroplasty for prosthetic joint infection to 2030. (B) Projections of revision total knee arthroplasty for prosthetic joint infection to 2030. Error bars are 95% confidence interval.
See this image and copyright information in PMC

References

    1. Fingar KR, Stocks C, Weiss AJ, Steiner CA. Most Frequent Operating Room Procedures Performed in U.S. Hospitals, 2003–2012: Statistical Brief #186, in Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville, MD: Agency for Healthcare Research and Quality (US); 2006. - PubMed
    1. Palsis JA, Brehmer TS, Pellegrini VD, Drew JM, Sachs BL. The cost of joint replacement: comparing two approaches to evaluating costs of total hip and knee arthroplasty. J Bone Joint Surg Am 2018;100:326–33. - PubMed
    1. Gabriel L, Casey J, Gee M, Palmer C, Sinha J, Moxham J, et al. Value-based healthcare analysis of joint replacement surgery for patients with primary hip osteoarthritis. BMJ Open Qual 2019;8:e000549. - PMC - PubMed
    1. Castagnini F, Sudanese A, Bordini B, Tassinari E, Stea S, Toni A. Total knee replacement in young patients: survival and causes of revision in a registry population. J Arthroplasty 2017;32:3368–72. - PubMed
    1. Gademan MG, Hofstede SN, Vliet Vlieland TP, Nelissen RG, Marang-van de Mheen PJ. Indication criteria for total hip or knee arthroplasty in osteoarthritis: a state-of-the-science overview. BMC Musculoskelet Disord 2016;17: 463. - PMC - PubMed

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