The projected volume of primary and revision total knee arthroplasty will place an immense burden on future health care systems over the next 30 years

Abstract

Purpose Total knee arthroplasty (TKA) rates have increased substantially in the recent decades worldwide, with Germany being one of the leading countries in the prevalence of TKA. The aim of this study was to provide an overview of treatment changes during the last decade and to project the expected burden of primary and revision TKA (rTKA) for the next 30 years. Methods Comprehensive nationwide data from Germany was used to quantify primary and revision TKA rates as a function of age and gender. Projections were performed with use of a Poisson regression models and a combination of exponential smoothing and autoregressive integrated moving average models on historical procedure rates in relation to official population projections from 2020 to 2050. Results The incidence rate of primary TKAs is projected to increase by around 43% to 299 per 100,000 inhabitants [95% CI 231-368], leading to a projected total number of 225,957 primary TKAs in 2050 (95% CI 178,804-276,442). This increase has been related to a growing number of TKA performed in male patients, with the highest increase modelled in patients between 50 and 65 years of age. At the same time, the annual total number of revision procedures is forecast to increase even more rapidly by almost 90%, accounting for 47,313 (95% CI 15,741-78,885; IR = 62.7 per 100,000, 95% CI 20.8-104.5) procedures by 2050. Those numbers are primarily associated with a rising number of rTKAs secondary to periprosthetic joint infection (PJI). Conclusions Using this country-specific forecast approach, a rising number of primary TKA and an even more rapidly growing number of rTKA, especially for PJI, has been projected until 2050, which will inevitably provide a huge challenge for the future health care system. As many other industrialized nations will face similar demographic and procedure-specific developments, these forecasts should be alarming for many health care systems worldwide and emphasize the tremendous need for an appropriate financial and human resource management in the future. Level of evidence Level III, prognostic study, economic and decision analysis.

Early Survivorship of Newly Designed Highly Porous Metaphyseal Tibial Cones in Revision Total Knee Arthroplasty

“…With the incidence of revision TKA continuing to increase worldwide [ [1] , [2] , [3] ], efficient techniques and solutions to address the challenges in revision TKA are needed. Managing bone loss and providing durable long-term fixation continues to be a major challenge in revision TKA, with aseptic loosening continuing to account for a high percentage of re-revision TKA indications [ 20 , 21 ].…”

“…The incidence of revision total knee arthroplasty (TKA) has risen over the last decade and is projected to continue to steadily increase worldwide over the next several decades [ [1] , [2] , [3] ]. Revision TKA presents a number of challenges for arthroplasty surgeons, namely prevention of periprosthetic joint infection (PJI), achieving stability, and managing bone loss [ 4 , 5 ].…”

Prevention at work needed to curb the worldwide strong increase in knee replacement surgery for working-age osteoarthritis patients

“…The largest increase in primary surgery demands is not among the classic knee arthroplasty population of patients aged 70 years and older, but among patients of working age ( 1 – 4 , 9 ). For instance, Germany – one of the leading countries in the prevalence of knee arthroplasty – foresees the highest increase in patients aged 50– 65 years until 2050 ( 10 ), and in a similar study using the same database even among patients aged 40–49 years until 2040 ( 11 ). In several countries, the current proportion of knee arthroplasty patients under 65 years is already substantial at 30–40%.…”

Role of D‐dimer and Fibrinogen in the Diagnosis of Periprosthetic Joint Infection: A Systematic Review and Meta‐Analysis

“…The incidence rate of PJI is estimated to range between 0.7% and 2.4% 5, 6 , and is expected to increase rapidly with an increase in prevalence of primary TJA. The number of revision knee arthroplasties is expected to grow at a high rate of nearly 90% each year and is expected to reach 47,313 cases by 2050, which is mainly due to the increase in PJI 7 . An early and accurate diagnosis of PJI is important for patients and surgeons.…”