The changing demographics of total joint arthroplasty recipients in the United States and Ontario from 2001 to 2007
The rates of total joint arthroplasty (TJA) of the hip and knee have increased in North America over the last decade. While initially designed for elderly patients (>70 years of age), several reports suggest that an increasing number of younger patients are undergoing joint replacements. This suggests that more people are meeting the indication for TJA earlier in their lives. Alternatively, it might indicate a broadening of the indications for TJA.
We used the administrative databases available at the Healthcare Cost and Utilization Project (HCUP) and the Institute for Clinical Evaluative Sciences (ICES) to determine the rates of TJA of the hip and knee in the United States, and Ontario, Canada, respectively. We determined the crude rates of THA and TKA in both areas for four calendar years (2001, 2003, 2005 and 2007). We also calculated the age- and sex-standardised rates of THA and TKA in both areas for each time period. We compared the age distribution of TJA recipients between the US and Ontario, and within each area over time.
The crude and standardised rates of THA and TKA increased over time in both the US and Ontario. The crude rates of THA were higher in the US in 2001 and 2003, but were not significantly different from the rate in Ontario in 2005 and 2007. The crude rates of TKA were consistently higher in the US for all time periods. In addition, the US consistently had more THA and TKA recipients in 'younger' age categories (<60 years of age). While the age- and sex-standardised rates of TKA were greater in the US in all time periods, the relative increase in rates from 2001 to 2007 was greater in Ontario (US - 59%, Ontario - 73%). For both the US and Ontario, there was a significant shift in the demographic of THA and TKA recipients to younger patients (p < 0.0001).
The utilisation of primary hip and knee arthroplasty has increased substantially in both the US and Ontario in the period from 2001 to 2007. This increase has been predominantly in knee replacements. The demographics of joint replacement recipients has become younger, with substantial increases in the prevalence of patients <60 years old amongst TJA recipients, and significant increases in the incidence of TJA in these age groups in the general population, in both the US and Ontario.
Available from: Javad Parvizi
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ABSTRACT: BACKGROUND: Although there is extensive literature supporting a high success rate, there are limited data on return to work after total knee arthroplasty (TKA). QUESTIONS/PURPOSES: We sought to determine (1) the percentage of patients who returned to work after TKA; (2) what percentage returned to their original job; (3) whether this varied based on the physical job demand category; and (4) whether there were differences between men and women in terms of the likelihood of returning to work after TKA. METHODS: A multicenter study was conducted of patients of working age (18-60 years) who underwent TKA 1 to 5 years previously. An independent third-party survey center with expertise in collecting healthcare data for state and federal agencies collected the data. Definitions from the US Department of Labor's Dictionary of Occupational Titles were used to determine physical job demand categories of sedentary, light, medium, heavy, and very heavy. Complete data were collected on 661 patients undergoing TKA (average age 54 years, 61% women). RESULTS: Seventy-five percent (494 of 661) were employed in the 3 months before their TKA and 98% (482 of 494) returned to work after surgery; 89% (440 of 494) returned to the same job. Before surgery, physical demand categories of the patients' jobs were sedentary 12%, light 10%, medium 24%, heavy 24%, and very heavy 30%. The return to work rate for those employed during the 3 months before surgery by physical demand category was sedentary 95%, light 91%, medium 100%, heavy 98%, and very heavy 97%. Men were more likely than women to have worked within the 3 months before TKA but there was no difference between sexes in return to work after TKA. CONCLUSIONS: In this group of young patients, most returned to work at their usual occupation after TKA. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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ABSTRACT: To determine if higher rates of surgery are associated with lower levels of need (patients' pre-operative reports of their symptoms, functional status and quality of life) and with less benefit (patients' post-operative reports).
Patient-reported outcome measures (PROMs) collected before and after joint replacement, hernia repair or varicose vein (VV) surgery in National Health Service (NHS)-funded patients (2009/11). Regression analysis for associations between 10% increase in rates and mean PROM score for Primary Care Trust (PCT) populations.
National rate for hip and knee replacement increased by 6%, unchanged for hernia repair and decreased by 26% for VV surgery. Changes in PCT rates varied but had little or no association with the mean level of need of patients: 10% increase in the rate was associated with only 0.3% decline in the pre-operative PROM score for knee replacement (P < 0.05) and VV surgery (P < 0.001) and no significant change for other procedures. There was no significant association between a 10% change in the rate and the amount of benefit from surgery apart from a slight reduction (0.46%; P < 0.001) in the disease-specific PROM score for VV surgery.
Policies by commissioners to reduce surgical rates in the English NHS cannot be justified on the grounds of avoiding inappropriate operations or increasing cost-utility.
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