International Orthopaedics

, Volume 35, Issue 12, pp 1783–1789 | Cite as

International survey of primary and revision total knee replacement

  • Steven M. KurtzEmail author
  • Kevin L. Ong
  • Edmund Lau
  • Marcel Widmer
  • Milka Maravic
  • Enrique Gómez-Barrena
  • Maria de Fátima de Pina
  • Valerio Manno
  • Marina Torre
  • William L. Walter
  • Richard de Steiger
  • Rudolph G. T. Geesink
  • Mikko Peltola
  • Christoph Röder
Original Paper



Total knee arthroplasty (TKA) is currently the international standard of care for treating degenerative and rheumatologic knee joint disease, as well as certain knee joint fractures. We sought to answer the following three research questions: (1) What is the international variance in primary and revision TKA rates around the world? (2) How do patient demographics (e.g., age, gender) vary internationally? (3) How have the rates of TKA utilization changed over time?


The survey included 18 countries with a total population of 755 million, and an estimated 1,324,000 annual primary and revision total knee procedures. Ten national inpatient databases were queried for this study from Canada, the United States, Finland, France, Germany, Italy, the Netherlands, Portugal, Spain, and Switzerland. Inpatient data were also compared with published registry data for eight countries with operating arthroplasty registers (Denmark, England & Wales, Norway, Romania, Scotland, Sweden, Australia, and New Zealand).


The average and median rate of primary and revision (combined) total knee replacement was 175 and 149 procedures/100,000 population, respectively, and ranged between 8.8 and 234 procedures/100,000 population. We observed that the procedure rate significantly increased over time for the countries in which historical data were available. The compound annual growth in the incidence of TKA ranged by country from 5.3% (France) to 17% (Portugal). We observed a nearly 27-fold range of TKA utilization rates between the 18 different countries included in the survey.


It is apparent from the results of this study that the demand for TKA has risen substantially over the past decade in countries around the world.


Total Knee Arthroplasty Total Knee Replacement Nationwide Inpatient Sample National Hospital Discharge Register Revision Knee Arthroplasty 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors would like to thank the Ministerio de Sanidad in Spain, the Ministry of Health in Italy, the Central Administration of the Portuguese Health System, and the Jing Gu from the Canadian Institute for Health Information for their assistance with providing data for this study. We further extend special thanks to Diana Dinslage and Gertrud Vierkant for their cooperation and help in creating the export file from the German Destatis database.

Conflict of Interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Steven M. Kurtz
    • 1
    • 12
    Email author
  • Kevin L. Ong
    • 1
  • Edmund Lau
    • 1
  • Marcel Widmer
    • 2
  • Milka Maravic
    • 3
  • Enrique Gómez-Barrena
    • 4
  • Maria de Fátima de Pina
    • 5
  • Valerio Manno
    • 6
  • Marina Torre
    • 6
  • William L. Walter
    • 7
  • Richard de Steiger
    • 8
  • Rudolph G. T. Geesink
    • 9
  • Mikko Peltola
    • 10
  • Christoph Röder
    • 11
  1. 1.Exponent, Inc.PhiladelphiaUSA
  2. 2.Swiss Health ObservatoryNeuchâtelSwitzerland
  3. 3.Département d’Information MédicaleHöpital Léopold BellanParisFrance
  4. 4.Universidad Autonoma de Madrid, Hospital La PazMadridSpain
  5. 5.Faculdade de Medicina and Instituto de Engenharia Biomédica - INEBUniversidade do PortoPortoPortugal
  6. 6.Istituto Superiore di SanitàRomeItaly
  7. 7.Mater ClinicSydneyAustralia
  8. 8.Australian Orthopedics Association National Joint RegistryAdelaideAustralia
  9. 9.University Medical Centre GroningenGroningenthe Netherlands
  10. 10.Centre for Health and Social Economics, National Institute for Health and Welfare (THL)HelsinkiFinland
  11. 11.Institute for Evaluative Research in MedicineUniversity of BernBernSwitzerland
  12. 12.Drexel UniversityPhiladelphiaUSA

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