Elsevier

Mayo Clinic Proceedings

Volume 85, Issue 10, October 2010, Pages 898-904
Mayo Clinic Proceedings

ORIGINAL ARTICLE
A Population-Based Study of Trends in the Use of Total Hip and Total Knee Arthroplasty, 1969-2008

https://doi.org/10.4065/mcp.2010.0115Get rights and content

OBJECTIVE

To study the rates of use of total hip arthroplasty (THA) and total knee arthroplasty (TKA) during the past 4 decades.

METHODS

The Rochester Epidemiology Project was used to identify all Olmsted County, Minnesota, residents who underwent THA or TKA from January 1, 1969, through December 31, 2008. We used a population-based approach because few data are available on long-term trends in the use of THA and TKA in the United States. Rates of use were determined by age- and sex-specific person-years at risk. Poisson regression was used to assess temporal trends by sex and age group.

RESULTS

The age- and sex-adjusted use of THA increased from 50.2 (95% confidence interval [CI], 40.5-59.8) per 100,000 person-years in 1969-1972 to 145.5 (95% CI, 134.2-156.9) in 2005-2008, whereas TKA increased markedly from 31.2 (95% CI, 25.3-37.1) per 100,000 person-years in 1971-1976 to 220.9 (95% CI, 206.7-235.0) in 2005-2008. For both procedures, use was greater among females, and the rate generally increased with age.

CONCLUSION

In this community, TKA and THA use rates have increased steadily since the introduction of the procedures and continue to increase for all age groups. On the basis of these population-based data, the probable need for TKA and THA exceeds current federal agency projections.

Section snippets

METHODS

Olmsted County is situated in southeastern Minnesota and is composed of approximately 124,000 people (2000 US Census), of whom 86,000 reside in the county's urban center, Rochester; more than 80% of the county population resides within 5 miles of the city. In 2000, 89% of the population was white and not of Hispanic origin (vs 69% nationwide). Although 25% of the county residents are employed in health care services (vs 8% nationwide) and the level of education is correspondingly higher (30%

RESULTS

From 1969 (when THA was first introduced) through 2008, a total of 2742 primary THAs were performed on 2209 Olmsted County residents. From 1971 (when TKA was first introduced) through 2008, 3488 primary TKAs were performed on 2479 residents. No patient had simultaneous bilateral THA, but 533 patients had both hips replaced on different dates. Three hundred thirty-nine patients had simultaneous bilateral TKA, whereas 670 others had both knees replaced on different dates.

DISCUSSION

This population-based study provides detailed data on trends in the use of THA and TKA among all age groups during a period exceeding 35 years in the United States. The age- and sex-adjusted primary THA use rate increased almost 2-fold between 1969-1972 and 2005-2008. Likewise, the age- and sex-adjusted use of primary TKA among Olmsted County residents increased markedly from 31.2 per 100,000 person-years in 1971-1976 to 220.9 per 100,000 person-years in 2005-2008, a more than 7-fold increase.

CONCLUSION

Our study demonstrates that, in a single US county where access to THA and TKA has been widely available, use rates have increased steadily since the introduction of the procedures, and they continue to increase in all age groups. Use has decreased for patients with rheumatoid arthritis and increased for patients with osteoarthritis. On the basis of these data, the probable need for THA and TKA in the United States exceeds national projections based on the NIS.10

REFERENCES (42)

  • NN Mahomed et al.

    Epidemiology of total knee replacement in the United States Medicare population

    J Bone Joint Surg Am

    (2005)
  • MG Peterson et al.

    Geographic variations in the rates of elective total hip and knee arthroplasties among Medicare beneficiaries in the United States

    J Bone Joint Surg Am

    (1992)
  • J Weinstein

    The Dartmouth Atlas of Musculoskeletal Health Care

    (2000)
  • S Kurtz et al.

    Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002

    J Bone Joint Surg Am

    (2005)
  • S Kurtz et al.

    Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030

    J Bone Joint Surg Am

    (2007)
  • CL Berthelsen

    Evaluation of coding data quality of the HCUP National Inpatient Sample

    Top Health Inf Manage

    (2000)
  • RM Coffey et al.

    The case for national health data standards

    Health Aff (Millwood)

    (1997)
  • A Jones et al.

    Racial disparity in knee arthroplasty utilization in the Veterans Health Administration

    Arthritis Rheum

    (2005)
  • A Escalante et al.

    Disparity in total hip replacement affecting Hispanic Medicare beneficiaries

    Med Care

    (2002)
  • US Department of Health and Human Services et al.

    NIH Consensus Statement on total knee replacement

    NIH Consens State Sci Statements

    (2003)
  • M Khatod et al.

    Knee replacement: epidemiology, outcomes, and trends in Southern California: 17,080 replacements from 1995 through 2004

    Acta Orthop

    (2008)
  • Cited by (0)

    This study was supported in part by research grant AR30582 from the National Institutes of Health, US Public Health Service, and a National Institutes of Health CTSA Award 1 KL2 RR024151-01 (Mayo Clinic Center for Clinical and Translational Research).

    An earlier version of this article appeared Online First.

    1

    Dr Singh is now with the Birmingham VA Medical Center and University of Alabama, Birmingham.

    2

    Dr Vessely is now with the Willamette Valley Medical Center, McMinnville, OR

    3

    Dr Berry receives royalties on selected hip and knee implants from DePuy, a Johnson & Johnson Company. Dr Singh has received speaker honoraria from Abbott; research and travel grants from Takeda, Savient, Wyeth, and Amgen; and consultant fees from Savient and URL Pharmaceuticals.

    View full text