Open AccessThe projected volume of primary and revision total knee arthroplasty will place an immense burden on future health care systems over the next 30 years
Author(s) -
Klug Alexander,
Gramlich Yves,
Rudert Maximilian,
Drees Philipp,
Hoffmann Reinhard,
Weißenberger Manuel,
Kutzner Karl Philipp
Publication year - 2021
Publication title -
knee surgery, sports traumatology, arthroscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.806
H-Index - 125
eISSN - 1433-7347
pISSN - 0942-2056
DOI - 10.1007/s00167-020-06154-7
Subject(s) - medicine , poisson regression , periprosthetic , total knee arthroplasty , population , demography , autoregressive integrated moving average , arthroplasty , surgery , statistics , environmental health , mathematics , time series , sociology
Purpose Total knee arthroplasty (TKA) rates have increased substantially in the recent decades worldwide, with Germany being one of the leading countries in the prevalence of TKA. The aim of this study was to provide an overview of treatment changes during the last decade and to project the expected burden of primary and revision TKA (rTKA) for the next 30 years. Methods Comprehensive nationwide data from Germany was used to quantify primary and revision TKA rates as a function of age and gender. Projections were performed with use of a Poisson regression models and a combination of exponential smoothing and autoregressive integrated moving average models on historical procedure rates in relation to official population projections from 2020 to 2050. Results The incidence rate of primary TKAs is projected to increase by around 43% to 299 per 100,000 inhabitants [95% CI 231–368], leading to a projected total number of 225,957 primary TKAs in 2050 (95% CI 178,804–276,442). This increase has been related to a growing number of TKA performed in male patients, with the highest increase modelled in patients between 50 and 65 years of age. At the same time, the annual total number of revision procedures is forecast to increase even more rapidly by almost 90%, accounting for 47,313 (95% CI 15,741–78,885; IR = 62.7 per 100,000, 95% CI 20.8–104.5) procedures by 2050. Those numbers are primarily associated with a rising number of rTKAs secondary to periprosthetic joint infection (PJI). Conclusions Using this country‐ specific forecast approach, a rising number of primary TKA and an even more rapidly growing number of rTKA, especially for PJI, has been projected until 2050, which will inevitably provide a huge challenge for the future health care system. As many other industrialized nations will face similar demographic and procedure‐specific developments, these forecasts should be alarming for many health care systems worldwide and emphasize the tremendous need for an appropriate financial and human resource management in the future. Level of evidence Level III, prognostic study, economic and decision analysis.