Kurtz SM, Mowat F, Ong K, et al. Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002

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The Journal of Bone and Joint Surgery (Impact Factor: 5.28). 08/2005; 87(7):1487-97. DOI: 10.2106/JBJS.D.02441
Source: PubMed


The purpose of this study was to quantify the procedural rate and revision burden of total hip and knee arthroplasty in the United States and to determine if the age or gender-based procedural rates and overall revision burden are changing over time.
The National Hospital Discharge Survey (NHDS) for 1990 through 2002 was used in conjunction with United States Census data to quantify the rates of primary and revision arthroplasty as a function of age and gender within the United States with use of methodology published by the American Academy of Orthopaedic Surgeons. Poisson regression analysis was used to evaluate the procedural rate and to determine year-to-year trends in primary and revision arthroplasty rates as a function of both age and gender.
Both the number and the rate of total hip and knee arthroplasties (particularly knee arthroplasties) increased steadily between 1990 and 2002. Over the thirteen years, the rate of primary total hip arthroplasties per 100,000 persons increased by approximately 50%, whereas the corresponding rate of primary total knee arthroplasties almost tripled. The rate of revision total hip arthroplasties increased by 3.7 procedures per 100,000 persons per decade, and that of revision total knee arthroplasties, by 5.4 procedures per 100,000 persons per decade. However, the mean revision burden of 17.5% for total hip arthroplasty was more than twice that for total knee arthroplasty (8.2%), and this did not change substantially over time.
The number and prevalence of primary hip and knee replacements increased substantially in the United States between 1990 and 2002, but the trend was considerably more pronounced for primary total knee arthroplasty.
The reported prevalence trends have important ramifications with regard to the number of joint replacements expected to be performed by orthopaedic surgeons in the future. Because the revision burden has been relatively constant over time, we can expect that a greater number of primary replacements will result in a greater number of revisions unless some limiting mechanism can be successfully implemented to reduce the future revision burden.

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Available from: Steven M Kurtz, Jan 08, 2014
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    • "Most patients experience dramatic pain relief, increased activity in daily life, and restored quality of life after THA. Because of the aging global population, the number of primary and revised THA procedures performed each year has increased significantly [1]. Moreover, the number of revision surgeries has increased annually, despite advances in surgical techniques and implant designs [2]. "
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    • "The number of total knee arthroplasty (TKA) performed has substantially increased over the past decade, therefore demand for TKA is projected to rise rapidly [1] [2] [3] [4] [5] [6] [7], and the need for revision TKA is also increasing [1–3,8–10]. Worldwide, periprosthetic joint infection (PJI) is one of the most common reasons for revision TKA [8,11–14], and is associated with high morbidity and substantial economic burden on the healthcare system [3] [15] [16]. "
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    ABSTRACT: The lack of standardized diagnostic criteria for periprosthetic joint infection (PJI) poses a challenge to accurate diagnosis of PJI. Recently, the Musculoskeletal Infection Society (MSIS) proposed diagnostic criteria for PJI. However, it is not known how well these proposed criteria accommodate real clinical scenarios. We determined what proportion of patients satisfied the MSIS criteria, and if MSIS criteria were not met, what other rationales were used to diagnose PJI. We retrospectively reviewed the records of 303 patients who underwent two-stage exchange arthroplasty for treatment of PJI of the knee at 17 institutions. The rationale for making the diagnosis of PJI was also recorded, if the case did not meet the MSIS criteria. In addition, detailed information about isolated microorganisms were gathered. Among the 303 patients, 198 met the diagnostic criteria proposed by MSIS. Among the 105 patients who did not meet the MSIS criteria, 88% met two or three minor criteria; however joint fluid analysis or histologic analysis was not performed in 85% of these 105 patients. The most common rationale for the diagnosis of PJI was the presence of abnormal physical findings. Microorganisms were identified in only 52% of all patients; the most common organism was coagulase-negative Staphylococcus. The diagnosis of PJI was based on clinical suspicion in approximately one-third of cases. In this series, joint aspiration or histological analysis was not performed in a large number of patients. Thus, surgeons should perform joint fluid and histologic analysis to assure the accuracy of PJI diagnosis. Copyright © 2015 Elsevier B.V. All rights reserved.
    The Knee 02/2015; 22(3). DOI:10.1016/j.knee.2015.02.004 · 1.94 Impact Factor
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    • "At the same time the total number of complications and revision surgery has also increased. Kurtz et al. reported a revision rate of 8% for all TKAs performed in the USA and aseptic loosening was cited as the most frequent reason for this [1]. Of all revisions, 23–71% were required because of aseptic loosening, 8.1–39% for instability, and 5–18.4% for infection [2] [3] [4] [5] [6] [7]. "
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