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. 2021 Oct;29(10):3287-3298.
doi: 10.1007/s00167-020-06154-7. Epub 2020 Jul 15.

The projected volume of primary and revision total knee arthroplasty will place an immense burden on future health care systems over the next 30 years

Alexander Klug  1 , Yves Gramlich  2 , Maximilian Rudert  3 , Philipp Drees  4 , Reinhard Hoffmann  2 , Manuel Weißenberger #  3 , Karl Philipp Kutzner  4   5
Affiliations

The projected volume of primary and revision total knee arthroplasty will place an immense burden on future health care systems over the next 30 years

Alexander Klug et al. Knee Surg Sports Traumatol Arthrosc. 2021 Oct.

Abstract

Purpose: Total knee arthroplasty (TKA) rates have increased substantially in the recent decades worldwide, with Germany being one of the leading countries in the prevalence of TKA. The aim of this study was to provide an overview of treatment changes during the last decade and to project the expected burden of primary and revision TKA (rTKA) for the next 30 years.

Methods: Comprehensive nationwide data from Germany was used to quantify primary and revision TKA rates as a function of age and gender. Projections were performed with use of a Poisson regression models and a combination of exponential smoothing and autoregressive integrated moving average models on historical procedure rates in relation to official population projections from 2020 to 2050.

Results: The incidence rate of primary TKAs is projected to increase by around 43% to 299 per 100,000 inhabitants [95% CI 231-368], leading to a projected total number of 225,957 primary TKAs in 2050 (95% CI 178,804-276,442). This increase has been related to a growing number of TKA performed in male patients, with the highest increase modelled in patients between 50 and 65 years of age. At the same time, the annual total number of revision procedures is forecast to increase even more rapidly by almost 90%, accounting for 47,313 (95% CI 15,741-78,885; IR = 62.7 per 100,000, 95% CI 20.8-104.5) procedures by 2050. Those numbers are primarily associated with a rising number of rTKAs secondary to periprosthetic joint infection (PJI).

Conclusions: Using this country- specific forecast approach, a rising number of primary TKA and an even more rapidly growing number of rTKA, especially for PJI, has been projected until 2050, which will inevitably provide a huge challenge for the future health care system. As many other industrialized nations will face similar demographic and procedure-specific developments, these forecasts should be alarming for many health care systems worldwide and emphasize the tremendous need for an appropriate financial and human resource management in the future.

Level of evidence: Level III, prognostic study, economic and decision analysis.

Keywords: Arthroplasty; Germany; Projection model; Revision knee arthroplasty; Total knee replacement.

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Conflict of interest statement

None of the authors, their immediate families, and any research foundation with which they are affiliated received any financial payments or other benefits from any commercial entity related to the subject of this article. Alexander Klug or any member of his or her immediate family, has no funding or commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. Manuel Weißenberger or any member of his or her immediate family, has no funding or commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. Reinhard Hoffmann or any member of his or her immediate family, has no funding or commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. Yves Gramlich or any member of his or her immediate family, has no funding or commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. Philipp Drees or any member of his or her immediate family, has no funding or commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. Maximilian Rudert or any member of his or her immediate family, has no funding or commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. KarlPhilipp Kutzner or any member of his or her immediate family, has no funding or commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

Figures

Fig. 1
Fig. 1
Projected total number of TKA until 2050 depending on the model used (confidence intervals in shades)
Fig. 2
Fig. 2
Projected incidence rate of TKA for men (blue) and women (red) until 2050 (per 100,000 inhabitants, Poisson modelling)
Fig. 3
Fig. 3
Projected total number of TKA (in thousands) for men (a) and women (b) per age age group until 2050
Fig. 4
Fig. 4
Projected total number of revision TKA for men (blue) and women (red) until 2050 (per 100,000 inhabitants, ARIMA modelling)
Fig. 5
Fig. 5
Projected total number of revision TKA (in thousands) for women (a) and men (b) per age age group until 2050
Fig. 6
Fig. 6
Projections of the proportional share of periprosthetic joint infections (PJI) for men (blue) and women (red) until 2050
See this image and copyright information in PMC

References

    1. Ackerman IN, Bohensky MA, Zomer E, et al. The projected burden of primary total knee and hip replacement for osteoarthritis in Australia to the year 2030. BMC Musculoskelet Disord. 2019;20:90. doi: 10.1186/s12891-019-2411-9. - DOI - PMC - PubMed
    1. Andreozzi V, Conteduca F, Iorio R, et al. Comorbidities rather than age affect medium-term outcome in octogenarian patients after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2019 doi: 10.1007/s00167-019-05788-6. - DOI - PubMed
    1. Bozdogan H. Model selection and Akaike's Information Criterion (AIC): the general theory and its analytical extensions. Psychometrika. 1987;52:345–370. doi: 10.1007/BF02294361. - DOI
    1. Chawla H, van der List JP, Christ AB, et al. Annual revision rates of partial versus total knee arthroplasty: a comparative meta-analysis. Knee. 2017;24:179–190. doi: 10.1016/j.knee.2016.11.006. - DOI - PubMed
    1. Culliford D, Maskell J, Judge A, et al. Future projections of total hip and knee arthroplasty in the UK: results from the UK Clinical Practice Research Datalink. Osteoarthr Cartil. 2015;23:594–600. doi: 10.1016/j.joca.2014.12.022. - DOI - PubMed