Regional Variation in Rates of Total Knee Arthroplasty Among Medicare Beneficiaries

Key Points Question How variable are rates of total knee arthroplasty across the United States after accounting for the prevalence of knee arthritis and other patient risk factors? Findings In this cohort study of more than 24 million Medicare beneficiaries annually from 2011 to 2015, observed to expected ratios for total knee arthroplasty ranged from 0.61 in Newark, New Jersey, to 1.82 in Idaho Falls, Idaho, suggesting areas of relative underuse and overuse. Regions with higher than expected rates were also associated with high rates among patients having relative contraindications to knee arthroplasty. Meaning Decision-making thresholds for performing total knee arthroplasty appear to differ across the US in a pattern suggesting overuse in some regions.