A Comprehensive Research on the Prevalence and Evolution Trend of Orthopedic Surgeries in Romania

Abstract

Accurate knowledge of the prevalence and trends of orthopedic surgeries can facilitate the design of medical plans for effective treatments. The National Endoprosthetic Registry (NER) in Romania provides statistics on endoprosthetic activity (hip, knee), cases of fractures and bone tumors as a result of the legal obligations to report interventions performed by all orthopedic traumatology hospitals/wards in the country. The aim of this study is to describe the annual volumes of orthopedic surgeries between 2001 and 2022 in Romania and analyze the current and future evolution trends of the studied surgeries, gender differences and regional differences based on a complete survey carried out at a national level. For the period 2001-2022, we extracted from the NER the annual volumes of orthopedic interventions performed. With these data, we studied the prevalence and estimated, with the support of an original calculation methodology, the variation trends of orthopedic surgeries in two situations: over the entire 21-year period, respectively, and over the period 2001-2020, which does not include the pandemic period. For hip replacement surgery and knee replacement surgery, we showed the prevalence by subcategory of interventions, gender distribution, regional prevalence and regional density calculated by the annual averages of the total number of cases reported per 100,000 people in the 40 counties of the country and the capital, Bucharest. We also determined the variations in hip and knee arthroplasty revision burdens, calculated as a percentage between the number of revisions and the number of primary interventions in the same period. We determined the regional densities of revision burdens. The total number of orthopedic surgeries in the period 2001-2022 was 1,557,247, of which 189,881 were hip replacement surgeries; 51,035 were knee replacement surgeries; 11,085 were revision hip arthroplasty; 1497 were revision knee arthroplasty; 541,440 were operated fractures; and 16,418 were operated bone tumors. The growth rates of surgical interventions are hip replacement surgery, +8.19%; knee replacement surgery, +19.55%; revision hip arthroplasty, +9.43%; and revision knee arthroplasty, +28.57%. With these data, we have estimated a doubling of the volume of primary and revision interventions of the hip until 2034 and the knee until 2027, respectively. Operated bone tumors register an annual decrease of -4.52% thanks to modern treatments. There are clear gender differences; for primary hip interventions, the proportion of women is 58.82%, and for knee interventions, the proportion of women is 76.42%. This is the first research that, with the support of exhaustive data from the NER, analyzes for the period 2001-2022 the annual number of orthopedic surgeries in Romania. It allows knowledge of the large, anticipated increases in orthopedic surgery and provides a quantitative basis for future policy decisions related to the need for medical personnel and material resources.

Keywords: National Endoprosthetic Registry; hip replacement surgery; knee replacement surgery; orthopedic surgeries; revision burden.

Figure 1

The percentage shares of orthopedic surgeries in the period 2001–2022.

Figure 2

Prevalence of annual orthopedic surgeries between 2001 and 2022 in Romania based on NER for hip replacement surgery, knee replacement surgery, revision hip arthroplasty, revision knee arthroplasty, operated fractures and operated bone tumors.

Figure 3

(a) Prevalence and (b) cumulative gender distribution of annual orthopedic surgeries between 2001 and 2022 in Romania based on RNE for hip replacement surgery: total hip arthroplasty (cemented total hip arthroplasty, uncemented total hip arthroplasty, hybrid and reverse hybrid total hip arthroplasty), bipolar hemiarthroplasty, unipolar hemiarthroplasty—Moore type.

Figure 3

(a) Prevalence and (b) cumulative gender distribution of annual orthopedic surgeries between 2001 and 2022 in Romania based on RNE for hip replacement surgery: total hip arthroplasty (cemented total hip arthroplasty, uncemented total hip arthroplasty, hybrid and reverse hybrid total hip arthroplasty), bipolar hemiarthroplasty, unipolar hemiarthroplasty—Moore type.

Figure 4

(a) Prevalence and (b) cumulative gender distribution of annual orthopedic surgeries between 2001 and 2022 in Romania based on NER for knee replacement surgery: bicondylar knee arthroplasty and unicondylar knee arthroplasty.

Figure 5

Hip and knee replacement surgeries in individual counties in period 2001–2022: (a) total numbers; (b) annual average.

Figure 6

Density map by county in the period 2001–2022 for (a) hip replacement surgery; (b) knee replacement surgery.

Figure 7

Variations of the hip and knee arthroplasties revision burdens at national level in the period 2001−2022.

Figure 8

Revision burden maps by county in the 2001–2022 period for (a) revision hip arthroplasty; (b) revision knee arthroplasty.