Trends in Bilateral Total Knee Arthroplasties: 153,259 Discharges between 1990 and 2004
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Information regarding national trends in bilateral TKAs is needed for a rational allocation of resources, policy making, and research. Therefore, we analyzed data from the National Hospital Discharge Survey to elucidate temporal changes in the demographics, comorbidity profiles, hospital stay, and in-hospital complications of patients undergoing bilateral TKAs in the United States. We created three 5-year periods: 1990–1994, 1995–1999, 2000–2004. Procedure, healthcare system, and patient-related variables were analyzed for an estimated 153,259 discharges. Use of bilateral TKAs more than doubled for the entire civilian population and almost tripled among the female population, with the steepest increase seen during the last two study periods. A decline of nearly 50% in the use of bilateral TKAs in patients 85 years and older was seen between the second and third study periods. The prevalence of coronary artery disease and pulmonary disease increased from the first to the second study periods but decreased from the second to the third. The changes in the variables studied may reflect a recently acquired reluctance to perform bilateral TKAs in elderly patients with cardiopulmonary comorbidities. Additional studies are necessary to identify other causal relationships and define the impact of these changes on various aspects of the healthcare system.
Level of Evidence: Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
- 3.Design and Operation of the National Hospital Discharge Survey: 1988 Redesign. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics; 1988.Google Scholar
- 7.Health, United States, 2006. Hyattsville, MD: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics; 2006.Google Scholar
- 9.International Classification of Diseases, 9th Revision, Clinical Modification [ICD-9-CM], 6th ed, 2008. Available at: http://icd9cm.chrisendres.com/. Accessed September 19, 2008.
- 19.Memtsoudis SG, Gonzalez Della Valle A, Besculides MC, Garber LK, Laskin RS. Trends in demographics, comorbidity profiles, in-hospital complications and mortality associated with primary knee arthroplasty: 3,830,420 hospital discharges in the United States between 1990 and 2004. J Arthroplasty. 2008 April 14. [Epub ahead of print]Google Scholar
- 20.Memtsoudis SG, Gonzalez Della Valle A, Besculides MC, Garber LK, Sculco TP. In-hospital complications and mortality of patients undergoing primary unilateral, bilateral and revision TKA: based on an estimate of4,169,489 discharges. Clin Orthop Relat Res. 2008;466:2617–2627.PubMedCrossRefGoogle Scholar
- 21.National Intercensal Estimates (1990–2000). US Census Bureau, 2007. Available at: http://www.census.gov/archives/EST90INTERCENSAL?US-EST()INT-04.html. Accessed August 15, 2008.
- 25.Primary total hip and total knee arthroplasty projections to 2030. Communication of the American Academy of Orthopaedic Surgeons. Rosemont, IL: American Academy of Orthopaedic Surgeons; 1998:7.Google Scholar
- 30.Robertsson O, Dunbar MJ, Knutson K, Lidgren L. Past incidence and future demand for knee arthroplasty in Sweden: a report from the Swedish Knee Arthroplasty Register regarding the effect of past and future population changes on the number of arthroplasties performed. Acta Orthop Scand. 2000;71:376–380.PubMedCrossRefGoogle Scholar
- 31.Selected articles using National Hospital Discharge Survey or National Survey of Ambulatory Surgery data. Centers for Disease Control and Prevention., 2007. Available at: http://www.cdc.gov/nchs/data/hdasd/NHDS2007articleupdate.pdf. Accessed August 15, 2008.