Projections and Epidemiology of Primary Hip and Knee Arthroplasty in Medicare Patients to 2040-2060

Abstract

Background:National projections of future joint arthroplasties are useful for understanding the changing burden of surgery and related outcomes on the health system. The aim of this study is to update the literature by producing Medicare projections for primary total joint arthroplasty (TJA) procedures until 2040 and 2060.Methods:The present study used data from the Centers for Medicare & Medicaid Services (CMS) Medicare/Medicaid Part B National Summary and combined procedure counts with use of Current Procedural Terminology (CPT) codes to identify whether the procedure was a primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) procedure. In 2019, the annual volume of primary TKA was 480,958 and that of primary THA was 262,369. These values formed a baseline from which we generated point forecasts for 2020-2060 and 95% forecast intervals (FIs).Results:Between 2000 and 2019, the estimated annual volume of THA increased by 177% and that of TKA increased by 156% on average. Regression analysis projected an annual growth rate of 5.2% for THA and 4.44% for TKA. Based on these yearly projected increases, an estimated increase of 28.84% and 24.28% is expected for each 5-year period after 2020 for THA and TKA, respectively. By 2040, the number of THAs is projected to be 719,364 (95% FI, 624,766 to 828,286) and the number of TKA is projected to be 1,222,988 (95% FI, 988,714 to 1,512,772). By 2060, the number of THAs is projected to be 1,982,099 (95% FI, 1,624,215 to 2,418,839) and the number of TKAs is projected to be 2,917,959 (95% FI, 2,160,951 to 3,940,156). In 2019, Medicare data showed that THA constituted approximately 35% of TJA procedures performed.Conclusions:Based on 2019 total volume counts, our model forecasts an increase in THA procedures of 176% by 2040 and 659% by 2060. The estimated increase for TKA is projected to be 139% by 2040 and 469% by 2060. An accurate projection of future primary TJA procedure demands is important in order to understand future health-care utilization and surgeon demand. This finding is only applicable to a Medicare population and demands further analysis to see if this extends to other population groups.Level of Evidence:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

What’s New in Adult Reconstructive Knee Surgery

“…Knee Surg Relat Res. 2023 Apr 27;35 (1): 12. This retrospective study aimed to assess the advantages of performing UKA on a single indicated side in patients undergoing simultaneous bilateral knee arthroplasty. The study compared 33 cases of simultaneous bilateral UKA and TKA with 99 cases of simultaneous bilateral TKA.…”

“…In addition to the articles cited already in this update, 9 other articles relevant to adult reconstructive knee surgery are appended to this review after the standard bibliography, with a brief commentary about each article to help guide your further reading, in an evidencebased fashion, in this subspecialty area. Jesus M. Villa, MD 1 Shayan Hosseinzadeh, MD 1 Carlos A. Higuera-Rueda, MD 1 1 Levitetz Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida Email for corresponding author: higuerc@ccf.org…”

“…An updated Medicare projection revealed that, by 2040, the annual number of revision total knee arthroplasties (TKAs) performed would be 115,147, whereas, by 2060, it would be 286,740. These values are important for understanding the future health-care resource utilization involving revision TKA, which is only expected to increase 1 . A secondary analysis of a randomized clinical trial (RCT) evaluating health-care resource utilization up to 12 months after primary TKA, among dissatisfied and satisfied patients, showed that patients dissatisfied with their return to function incurred a mean cost of $19,007.70, compared with $13,523.83 for satisfied patients (p = 0.07).…”

The reimbursement system can influence the treatment choice and favor joint replacement versus other less invasive solutions in patients affected by osteoarthritis

“…Total joint arthroplasty (TJA) is considered one of the most successful surgical innovations of the 20th century, thanks to its proved efficacy in relieving pain and improving function in a durable and cost‐effective manner when appropriately indicated [1, 40, 63]. The volume of these procedures has risen dramatically over the past several decades, with over 800,000 total hip and knee arthroplasties being performed annually in the United States only [17, 24, 32, 72]. Moreover, a further increase is expected with 1.22 million prostheses foreseen by 2040 in the United States [72].…”

“…The volume of these procedures has risen dramatically over the past several decades, with over 800,000 total hip and knee arthroplasties being performed annually in the United States only [17, 24, 32, 72]. Moreover, a further increase is expected with 1.22 million prostheses foreseen by 2040 in the United States [72]. This implies important consequences for the healthcare systems [61, 72].…”