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    New Study Projects the Future Volume of Primary and Revision TJAs in the US

    According to the National Inpatient Sample, 370,770 total hip arthroplasty (THA) and 680,150 total knee arthroplasty (TKA) procedures were performed in the US in 2014, making total joint arthroplasty (TJA) one of the most commonly performed elective surgical procedures.

    The volume of primary and revision TJAs has risen continuously in recent decades, and a new study presented at the 2018 Annual Meeting of the American Academy of Orthopaedic Surgeons used statistical modeling to predict future volume of TJA procedures in the US.

    A linear regression model showed that overall, the volume of primary and revision TJAs in the future will be significantly lower than has been reported in studies using exponential growth models. Sub-population prevalence was combined with census projections to predict national procedure volume for 2030 to 2060, followed by a pairwise correlation to assess consistency among models. As a result, these data findings can help guide healthcare economic policy and allocation of future resources to optimize the delivery of patient care.

    “We were particularly interested in the predictions for TJA, as the projected volume of procedures by 2030 and 2060 was very high,” said Matthew Sloan, MD, orthopaedic resident at the University of Pennsylvania and lead author of the study. “We went into our study thinking that the previously anticipated exponential growth among these procedures was not consistent with current trends, and it might be an overestimate.”

    Dr. Sloan and his colleagues found that:

    • By 2030, primary THA is projected to grow 171% and primary TKA is projected to grow by up to 189%, for a projected 635,000 and 1.28 million procedures, respectively.
    • Similar gains are expected for revision THA and TKA, growing by 142% (72,000 procedures) and 190% (120,000 procedures), respectively.
    • By 2060, primary THA is expected to reach 1.23 million procedures (330% increase), primary TKA is expected to reach 2.60 million procedures (382% increase), revision THA is expected to reach 110,000 procedures (219% increase), and revision TKA is expected to reach 253,000 procedures (400% increase).
    • TKA procedure growth rate slowed between 2008 and 2014.

    “These numbers are always changing,” Dr. Sloan noted. “We will continue to look at new data as the numbers need to be constantly updated, especially if they are used to make predictions for future healthcare saving decisions, as the impact can be in the millions of dollars.

    “It’s imperative to provide policy makers with high-quality data to inform decisions that will affect patient access to orthopaedic care and the financial viability of elective orthopedic procedures.”

    In related research also presented at the 2018 Annual Meeting, Dr. Sloan and his colleagues examined the changing demographics in TJA in the US from 2000 to 2014.

    They found that:

    • The mean age for primary THA has declined significantly from 66.3 years to 64.9 years. For primary TKA, mean age has decreased from 68 years to 65.9 years.
    • Females continue to make up the majority of patients at 55% to 62%.
    • Non-Hispanic whites comprise 80% to 86% of the TJA population, followed by blacks (8% to 11%), Hispanics (3% to 6%), and Asians (less than 1%).
    • The proportion of Non-Hispanic whites has been decreasing over time as the proportion of blacks has increased, with minimal change among the proportion of Asians and Hispanics undergoing TJR procedures.

    Sources

    Sloan M, Sheth NP. Projected Volume of Primary and Revision Total Joint Arthroplasty in the United States, 2030-2060 (Paper 016). Presented at the 2018 Annual Meeting of the American Academy of Orthopaedic Surgeons, March 6-10, 2018, New Orleans, Louisiana.

    Sloan M, Sheth NP. Changing Demographics in Primary and Revision Total Joint Arthroplasty, 2000-2014. (Poster P0016) Presented at the 2018 Annual Meeting of the American Academy of Orthopaedic Surgeons, March 6-10, 2018, New Orleans, Louisiana.