Despite COVID-19, the Number of Joint Replacement Procedures Increased in 2020

    The initial impact of the COVID-19 pandemic may have temporarily paused elective joint replacement procedures for 3 months (March to May 2020), but it did not halt the growth of hip and knee arthroplasty last year.

    Data from the 2021 Annual Report from the American Joint Replacement Registry (AJRR) show that despite the disruption in service, 2020 was a banner year for hip and knee arthroplasty, with overall cumulative procedural volume growth of 18.3% compared with the previous year. The AJRR now includes the findings from nearly 2.25 million hip and knee arthroplasty procedures performed between 2012 and 2020.

    “The ability to return to normal procedural volume rates just a few months after the COVID-19 pandemic began is a testament to the commitment and resiliency of healthcare institutions, clinicians, and patients,” said Bryan D. Springer, MD, chair of the AJRR Steering Committee.

    Practice Patterns

    The 2021 Annual Report from AJRR, the largest orthopaedic registry in the world based on annual procedures submitted, describes hip and knee arthroplasty procedural trends and patient outcomes based on data from more than 1,150 hospitals, ambulatory surgery centers (ASCs), and private practice groups in all 50 states and the District of Columbia.

    “While we are experiencing unprecedented times in healthcare and continue to navigate the challenges of the pandemic, the AJRR remains committed to the growth and expansion of the registry to paint a more complete picture of our patient population,” Dr. Springer said. “Through increased participation and a successful integration of Medicare claims data, we are providing orthopaedic surgeons, hospitals and stakeholders with actionable data, insights and trends to improve the lives of millions of Americans who suffer from hip and knee arthritis.”

    James A. Browne, MD, chair of the AJRR Publications Subcommittee and editor of AJRR Publications added, “This year’s AJRR Annual Report provides the most comprehensive picture to date of patterns of hip and knee arthroplasty practice and outcomes in the United States.

    “For the first time this year, cumulative percent revision curves were produced with a diagnosis-specific endpoint examining revision due to infection for total knee arthroplasty and revision due to periprosthetic fracture for total hip arthroplasty patients over 65 years of age. The registry continues to use more sophisticated and detailed survivorship curves, including device-specific cumulative revision stratified by bearing and fixation type, in addition to utilizing Centers for Medicare & Medicaid Services data.”

    Report Findings

    Findings from AJRR’s 2021 Annual Report include the following:

    • Device-specific revision analyses show that all included hip device constructs had a cumulative percent revision of less than 2.8% at 1 year and less than 4.7% at final follow-up for each respective device.
    • All knee device constructs included in analysis had a cumulative percent revision of less than 2.5% at 3 years and less than 3.7% at final follow-up for each respective device.
    • Compared with cementless fixation in elective primary total hip arthroplasty (THA) patients age 65 and older, the use of cement for femoral component fixation is slowly increasing for both elective primary THA and arthroplasty for femoral neck fracture. Cementless fixation shows a statistically significant reduction in early revision due to periprosthetic fracture.
    • Although cemented fixation for total knee arthroplasty (TKA) still predominates, cementless fixation continues to increase and was associated with significantly fewer revisions due to infection in elective primary TKA patients over age 65.
    • Postoperative length of stay continues to decrease for both THA and TKA procedures.

    Download the complete 2021 report here. Slides with figures and data tables as featured in the report are also available.

    The 2020 Annual Report

    ICJR’s coverage of data from AJRR’s 2020 Annual Report, which covers procedures from 2012 to 2019, can be found in these 7 articles:

    REGISTRY REVIEW: An Overview of Hip and Knee Arthroplasty in the US

    REGISTRY REVIEW: Partial Knee Arthroplasty in the US

    REGISTRY REVIEW: Hip Arthroplasty for Displaced Femoral Neck Fractures

    REGISTRY REVIEW: Primary Total Knee Arthroplasty in the US

    REGISTRY REVIEW: Primary Total Hip Arthroplasty in the US

    REGISTRY REVIEW: Revision Total Knee Arthroplasty in the US

    REGISTRY REVIEW: Revision Total Hip Arthroplasty in the US