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Research ArticleArticle

Rates of Total Joint Replacement in the United States: Future Projections to 2020–2040 Using the National Inpatient Sample

Jasvinder A. Singh, Shaohua Yu, Lang Chen and John D. Cleveland
The Journal of Rheumatology April 2019, jrheum.170990; DOI: https://doi.org/10.3899/jrheum.170990
Jasvinder A. Singh
From the Medicine Service, Birmingham VA Medical Center; Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama, Birmingham, Alabama, USA. This work is supported by research funds from the Division of Rheumatology at the University of Alabama at Birmingham and the resources and use of facilities at the Birmingham VA Medical Center. The funding body did not play any role in the study design or in the collection, analysis, and interpretation of data; in the writing of the manuscript; or in the decision to submit the manuscript for publication. JAS is a member of the American College of Rheumatology’s (ACR) Annual Meeting Planning Committee; Chair of the ACR Meet-the-Professor, Workshop and Study Group Subcommittee; and a member of the Veterans Affairs Rheumatology Field Advisory Committee. JAS is the editor and Director of the UAB Cochrane Musculoskeletal Group Satellite Center on Network Metaanalysis. J.A. Singh, MBBS, MPH, Medicine Service, Birmingham VA Medical Center, and Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama; S. Yu, MS, Department of Medicine at School of Medicine, University of Alabama; L. Chen, PhD, Department of Medicine at School of Medicine, University of Alabama; J.D. Cleveland, MS, Department of Medicine at School of Medicine, University of Alabama. Address correspondence to J.A. Singh, University of Alabama, Faculty Office Tower 805B, 510 20th St. S, Birmingham, Alabama 35294, USA. E-mail: Jasvinder.md@gmail.com. Accepted for publication November 13, 2018.
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Shaohua Yu
From the Medicine Service, Birmingham VA Medical Center; Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama, Birmingham, Alabama, USA. This work is supported by research funds from the Division of Rheumatology at the University of Alabama at Birmingham and the resources and use of facilities at the Birmingham VA Medical Center. The funding body did not play any role in the study design or in the collection, analysis, and interpretation of data; in the writing of the manuscript; or in the decision to submit the manuscript for publication. JAS is a member of the American College of Rheumatology’s (ACR) Annual Meeting Planning Committee; Chair of the ACR Meet-the-Professor, Workshop and Study Group Subcommittee; and a member of the Veterans Affairs Rheumatology Field Advisory Committee. JAS is the editor and Director of the UAB Cochrane Musculoskeletal Group Satellite Center on Network Metaanalysis. J.A. Singh, MBBS, MPH, Medicine Service, Birmingham VA Medical Center, and Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama; S. Yu, MS, Department of Medicine at School of Medicine, University of Alabama; L. Chen, PhD, Department of Medicine at School of Medicine, University of Alabama; J.D. Cleveland, MS, Department of Medicine at School of Medicine, University of Alabama. Address correspondence to J.A. Singh, University of Alabama, Faculty Office Tower 805B, 510 20th St. S, Birmingham, Alabama 35294, USA. E-mail: Jasvinder.md@gmail.com. Accepted for publication November 13, 2018.
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Lang Chen
From the Medicine Service, Birmingham VA Medical Center; Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama, Birmingham, Alabama, USA. This work is supported by research funds from the Division of Rheumatology at the University of Alabama at Birmingham and the resources and use of facilities at the Birmingham VA Medical Center. The funding body did not play any role in the study design or in the collection, analysis, and interpretation of data; in the writing of the manuscript; or in the decision to submit the manuscript for publication. JAS is a member of the American College of Rheumatology’s (ACR) Annual Meeting Planning Committee; Chair of the ACR Meet-the-Professor, Workshop and Study Group Subcommittee; and a member of the Veterans Affairs Rheumatology Field Advisory Committee. JAS is the editor and Director of the UAB Cochrane Musculoskeletal Group Satellite Center on Network Metaanalysis. J.A. Singh, MBBS, MPH, Medicine Service, Birmingham VA Medical Center, and Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama; S. Yu, MS, Department of Medicine at School of Medicine, University of Alabama; L. Chen, PhD, Department of Medicine at School of Medicine, University of Alabama; J.D. Cleveland, MS, Department of Medicine at School of Medicine, University of Alabama. Address correspondence to J.A. Singh, University of Alabama, Faculty Office Tower 805B, 510 20th St. S, Birmingham, Alabama 35294, USA. E-mail: Jasvinder.md@gmail.com. Accepted for publication November 13, 2018.
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John D. Cleveland
From the Medicine Service, Birmingham VA Medical Center; Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama, Birmingham, Alabama, USA. This work is supported by research funds from the Division of Rheumatology at the University of Alabama at Birmingham and the resources and use of facilities at the Birmingham VA Medical Center. The funding body did not play any role in the study design or in the collection, analysis, and interpretation of data; in the writing of the manuscript; or in the decision to submit the manuscript for publication. JAS is a member of the American College of Rheumatology’s (ACR) Annual Meeting Planning Committee; Chair of the ACR Meet-the-Professor, Workshop and Study Group Subcommittee; and a member of the Veterans Affairs Rheumatology Field Advisory Committee. JAS is the editor and Director of the UAB Cochrane Musculoskeletal Group Satellite Center on Network Metaanalysis. J.A. Singh, MBBS, MPH, Medicine Service, Birmingham VA Medical Center, and Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama; S. Yu, MS, Department of Medicine at School of Medicine, University of Alabama; L. Chen, PhD, Department of Medicine at School of Medicine, University of Alabama; J.D. Cleveland, MS, Department of Medicine at School of Medicine, University of Alabama. Address correspondence to J.A. Singh, University of Alabama, Faculty Office Tower 805B, 510 20th St. S, Birmingham, Alabama 35294, USA. E-mail: Jasvinder.md@gmail.com. Accepted for publication November 13, 2018.
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Abstract

Objective To project future total hip and knee joint arthroplasty (THA, TKA) use in the United States to 2040.

Methods We used the 2000–2014 US National Inpatient Sample (NIS) combined with Census Bureau data to develop projections for primary THA and TKA from 2020 to 2040 using polynomial regression to account for the nonlinearity and interactions between the variables, assuming the underlying distribution of the number of THA/TKA to be Poisson distributed. We performed sensitivity analyses using a negative binomial regression to account for overdispersion.

Results Predicted total annual counts (95% prediction intervals) for THA in the United States by 2020, 2025, 2030, and 2040 are (in thousands): 498 (475, 523), 652 (610, 696), 850 (781, 925), and 1429 (1265, 1615), respectively. For primary TKA, predicted total annual counts for 2020, 2025, 2030, and 2040 are (in thousands): 1065 (937, 1211), 1272 (1200, 1710), 1921 (1530, 2410), and 3416 (2459, 4745), respectively. Compared to the available 2014 NIS numbers, the percent increases in projected total annual US use for primary THA and TKA in 2020, 2025, 2030, and 2040 are as follows: primary THA, by 34%, 75%, 129%, and 284%; and primary TKA, 56%, 110%, 182%, and 401%, respectively. Primary THA and TKA use is projected to increase for both females and males, in all age groups.

Conclusion Significant increases in use of THA and TKA are expected in the United States in the future, if the current trend continues. The increased use is evident across age groups in both females and males. A policy change may be needed to meet increased demand.

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Rates of Total Joint Replacement in the United States: Future Projections to 2020–2040 Using the National Inpatient Sample
Jasvinder A. Singh, Shaohua Yu, Lang Chen, John D. Cleveland
The Journal of Rheumatology Apr 2019, jrheum.170990; DOI: 10.3899/jrheum.170990

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Rates of Total Joint Replacement in the United States: Future Projections to 2020–2040 Using the National Inpatient Sample
Jasvinder A. Singh, Shaohua Yu, Lang Chen, John D. Cleveland
The Journal of Rheumatology Apr 2019, jrheum.170990; DOI: 10.3899/jrheum.170990
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