Advertisement

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

Abstract

Purpose

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?

Methods

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).

Results

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.

Conclusion

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.

Keywords

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.

Notes

Acknowledgements

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.

References

  1. 1.
    Serra-Sutton V, Allepuz A, Espallargues M, Labek G, Pons JM (2009) Arthroplasty registers: a review of international experiences. Int J Technol Assess Health Care 25(1):63–72. doi: 10.1017/S0266462309090096 PubMedCrossRefGoogle Scholar
  2. 2.
    Losina E, Walensky RP, Kessler CL, Emrani PS, Reichmann WM, Wright EA, et al. (2009) Cost-effectiveness of total knee arthroplasty in the United States: patient risk and hospital volume. Arch Intern Med 169(12):1113–1121; discussion 1121–1112. doi: 10.1001/archinternmed.2009.136.Google Scholar
  3. 3.
    Krummenauer F, Wolf C, Gunther KP, Kirschner S (2009) Clinical benefit and cost effectiveness of total knee arthroplasty in the older patient. Eur J Med Res 14(2):76–84PubMedGoogle Scholar
  4. 4.
    Rasanen P, Paavolainen P, Sintonen H, Koivisto AM, Blom M, Ryynanen OP et al (2007) Effectiveness of hip or knee replacement surgery in terms of quality-adjusted life years and costs. Acta Orthop 78(1):108–115. doi: 10.1080/17453670610013501 PubMedCrossRefGoogle Scholar
  5. 5.
    Burns AW, Bourne RB, Chesworth BM, MacDonald SJ, Rorabeck CH (2006) Cost effectiveness of revision total knee arthroplasty. Clin Orthop Relat Res 446:29–33. doi: 10.1097/01.blo.0000214420.14088.76 PubMedCrossRefGoogle Scholar
  6. 6.
    Hirsch HS (1998) Total joint replacement: a cost-effective procedure for the 1990s. Med Health RI 81(5):162–164Google Scholar
  7. 7.
    Scheerlinck T, Druyts P, Casteleyn PP (2004) The use of primary total hip arthroplasty in university hospitals of the European Union. Acta Orthop Belg 70(3):231–239PubMedGoogle Scholar
  8. 8.
    Labek G, Stoica CI, Bohler N (2008) Comparison of the information in arthroplasty registers from different countries. J Bone Joint Surg Br 90(3):288–291. doi: 10.1302/0301-620X.90B3.19556 PubMedCrossRefGoogle Scholar
  9. 9.
    Kurtz SM, Mowat F, Ong K, Chan N, Lau E, Halpern M (2005) Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg Am 87(7):1487–1497PubMedCrossRefGoogle Scholar
  10. 10.
    Kurtz S, Ong K, Lau E, Mowat F, Halpern M (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 89(4):780–785. doi: 10.2106/JBJS.F.00222 PubMedCrossRefGoogle Scholar
  11. 11.
    Kurtz SM, Lau E, Ong K, Zhao K, Kelly M, Bozic KJ (2009) Future young patient demand for primary and revision joint replacement: national projections from 2010 to 2030. Clin Orthop Relat Res 467(10):2606–2612. doi: 10.1007/s11999-009-0834-6 PubMedCrossRefGoogle Scholar
  12. 12.
    de Bruin A, Kardaun J, Gast F, de Bruin E, van Sijl M, Verweij G (2004) Record linkage of hospital discharge register with population register: experiences at Statistics Netherlands. Statistical Journal of the UN Economic Commission for Europe, IOS Press, 21(1):23–32Google Scholar
  13. 13.
    Australian Orthopaedic Association (2010) National Joint Replacement Registry. Annual report. Available from: http://www.dmac.adelaide.edu.au/aoanjrr/publications.jsp. Accessed 22 February 2011
  14. 14.
    Willis-Owen CA, Brust K, Alsop H, Miraldo M, Cobb JP (2009) Unicondylar knee arthroplasty in the UK National Health Service: an analysis of candidacy, outcome and cost efficacy. Knee 16(6):473–478. doi: 10.1016/j.knee.2009.04.006 PubMedCrossRefGoogle Scholar
  15. 15.
    Robertsson O (2007) Knee arthroplasty registers. J Bone Joint Surg Br 89(1):1–4. doi: 10.1302/0301-620X.89B1.18327 PubMedGoogle Scholar
  16. 16.
    von Knoch F, Malchau H (2009) Why do we need a national joint replacement registry in the United States? Am J Orthop (Belle Mead NJ) 38(10):500–503Google Scholar
  17. 17.
    Culliford DJ, Maskell J, Beard DJ, Murray DW, Price AJ, Arden NK (2010) Temporal trends in hip and knee replacement in the United Kingdom: 1991 to 2006. J Bone Joint Surg Br 92(1):130–135. doi: 10.1302/0301-620X.92B1.22654 PubMedCrossRefGoogle Scholar
  18. 18.
    Kim HA, Kim S, Seo YI, Choi HJ, Seong SC, Song YW et al (2008) The epidemiology of total knee replacement in South Korea: national registry data. Rheumatol Oxf 47(1):88–91. doi: 10.1093/rheumatology/kem308 CrossRefGoogle Scholar
  19. 19.
    Romanini E, Manno V, Conti S, Baglio G, Di Gennaro S, Masciocchi M et al (2009) Interregional mobility for total knee arthroplasty. Ann Ig 21(4):329–336PubMedGoogle Scholar
  20. 20.
    Kadono Y, Yasunaga H, Horiguchi H, Hashimoto H, Matsuda S, Tanaka S et al (2010) Statistics for orthopedic surgery 2006–2007: data from the Japanese Diagnosis Procedure Combination database. J Orthop Sci 15(2):162–170. doi: 10.1007/s00776-009-1448-2 PubMedCrossRefGoogle Scholar

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

Personalised recommendations