Primary, revision THA, TKA expected to surge by 2030

By Elaine Fiedler

By 2030, orthopaedic surgeons in the United States could be performing more than 571,100 primary total hip arthroplasties (THA) and an estimated 3.48 million total knee arthroplasties (TKA), according to projections presented by the authors of Paper 403 yesterday.

As the number of primary hip and knee arthroplasties increases each year, the number of revision surgeries can also be expected to increase. Previous analyses of nationwide procedure data indicate that the revision burden—the ratio of revisions to the total number of arthroplasties—has remained relatively constant, at approximately 17.5 percent for THA and 8.2 percent for TKA.

According to the authors’ projections, based on current trends, the number of THA revisions will increase 137 percent over the next 25 years—from an estimated 40,800 in 2005 to approximately 96,700 in 2030. The number of revision TKAs will swell from an estimated 38,300 in 2005 to more than 268,200 in 2030—a 601 percent increase.

Because the United States does not have a national arthroplasty registry, the authors used data from the Nationwide Inpatient Sample (1990-2003)—an annual federal-state program that compiles a representative sample of hospital discharge records—in conjunction with U.S. census data for this Level I economic and decision analysis.

Estimated projections in hip and knee arthroplasty were developed using a Poisson regression model that incorporated the growth in population and rate of surgeries as a function of age, gender, race, and census region.

Results showed that while it will take until 2026 for the total number of revision THA procedures performed in 2005 to double, the number of revision TKA procedures performed in 2005 will double about a decade earlier, in 2015.

The authors believe that their study provides, for the first time, data-based projections of the future number of revision surgeries in the U.S. through 2030. Such a large increase in hip and knee surgeries would have serious consequences. As the authors said, “Given the many years required in the training of surgeons and the equally complex task of planning for hospital capacity, reliable data on future needs for arthroplasty surgeries are crucial for policy makers in government, education and industry…The projections demonstrate a massive expected demand for primary and revision surgeries in the next two decades, a demand that will need to be addressed with a combination of increased economic resources, operative efficiency, technical capacity (i.e., additional surgeons) and implant longevity.”

The authors included Steven M Kurtz, PhD; Kevin Ong, PhD; Edmund Lau, MS; Fionna Mowat, PhD; and Michael Halpern, MPH, MD, PhD, all of Philadelphia.

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