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. 2022 May 21:15:188-195.e6.
doi: 10.1016/j.artd.2022.03.004. eCollection 2022 Jun.

Epidemiology of Revision Total Knee Arthroplasty in the United States, 2012 to 2019

Alexander Upfill-Brown  1 , Peter P Hsiue  1 , Troy Sekimura  1 , Brendan Shi  1 , Seth A Ahlquist  1 , Jay N Patel  1 , Micah Adamson  1 , Alexandra I Stavrakis  1
Affiliations

Epidemiology of Revision Total Knee Arthroplasty in the United States, 2012 to 2019

Alexander Upfill-Brown et al. Arthroplast Today. .

Abstract

Background: As primary total knee arthroplasty volume continues to increase, so will the number of revision total knee arthroplasty (rTKA) procedures. The purpose of this study is to provide an updated perspective on the incidence, indications, and financial burden of rTKA in the United States.

Material and methods: This was a retrospective epidemiologic analysis using the National Inpatient Sample. International Classification of Diseases ninth and tenth revision codes were used to identify patients who underwent rTKA and create cohorts based on rTKA indications from 2012 to 2019. National and regional trends for length of stay, cost, and discharge location were evaluated.

Results: A total of 505,160 rTKA procedures were identified. The annual number of rTKA procedures increased by 29.6% over the study period (56,490 to 73,205). The top 3 indications for rTKA were aseptic loosening (23.1%), periprosthetic joint infection (PJI) (20.4%), and instability (11.0%). Over the study period, the proportion of patients discharged to skilled nursing facility decreased from 31.7% to 24.1% (P < .001). Hospital length of stay decreased from 4.0 days in 2012 to 3.8 days in 2019 (P < .001). Hospital costs increased by $1300 from $25,730 to $27,077 (P < .001). The proportion of rTKA cases performed at urban academic centers increased (52.1% to 74.3%, P < .001) while that at urban nonacademic centers decreased (39.0% to 19.2%, P < .001).

Conclusion: The top 3 indications for rTKA were aseptic loosening, PJI, and instability, with PJI becoming the most common indication in 2019. These cases are increasingly being performed at urban academic centers and away from urban nonacademic centers.

Level of evidence: 3 (Retrospective cohort study).

Keywords: Clinical epidemiology; Healthcare resource utilization; National trends; Revision total knee arthroplasty.

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Figures

Figure 1
Figure 1
Trends in annual rTKA by primary associated indication for overall proportion (a), mean hospital costs (b), length of stay (c), and proportion of discharge to facility (d). Vertical bars represent 95% confidence intervals.
Figure 2
Figure 2
Total hospital costs (a) and length of stay (b) by US census region. Vertical bars represent 95% CI. US dollars adjusted for inflation, represented as December 2019 US dollars.
Figure 3
Figure 3
Total hospital costs (a) and length of stay (b) by hospital type. Vertical bars represent 95% CI. US dollars adjusted for inflation, represented as December 2019 US dollars.
See this image and copyright information in PMC

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