International survey of primary and revision total knee replacement

Exponent, Inc., Philadelphia, PA 19104, USA.
International Orthopaedics (Impact Factor: 2.11). 03/2011; 35(12):1783-9. DOI: 10.1007/s00264-011-1235-5
Source: PubMed


Total knee arthroplasty (TKA) is currently the international standard of care for treating degenerative and rheumatologic knee joint disease, as well as certain knee joint fractures. We sought to answer the following three research questions: (1) What is the international variance in primary and revision TKA rates around the world? (2) How do patient demographics (e.g., age, gender) vary internationally? (3) How have the rates of TKA utilization changed over time?
The survey included 18 countries with a total population of 755 million, and an estimated 1,324,000 annual primary and revision total knee procedures. Ten national inpatient databases were queried for this study from Canada, the United States, Finland, France, Germany, Italy, the Netherlands, Portugal, Spain, and Switzerland. Inpatient data were also compared with published registry data for eight countries with operating arthroplasty registers (Denmark, England & Wales, Norway, Romania, Scotland, Sweden, Australia, and New Zealand).
The average and median rate of primary and revision (combined) total knee replacement was 175 and 149 procedures/100,000 population, respectively, and ranged between 8.8 and 234 procedures/100,000 population. We observed that the procedure rate significantly increased over time for the countries in which historical data were available. The compound annual growth in the incidence of TKA ranged by country from 5.3% (France) to 17% (Portugal). We observed a nearly 27-fold range of TKA utilization rates between the 18 different countries included in the survey.
It is apparent from the results of this study that the demand for TKA has risen substantially over the past decade in countries around the world.

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Available from: Marcel Widmer
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    • "Total knee arthroplasty (TKA) is the standard treatment for end stage degenerative and rheumatologic knee diseases [3, 18]. The main reasons for revision are mechanical failure (instability, polyethylene wear, malposition, impingement, over-/undersizing), aseptic loosening and infection [9]. "
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    ABSTRACT: The aim of this study was to analyse the long-term (>ten years) survival rate and radiological results of the Duracon TKA. Between 1992 and 1999 159 Duracon TKA were implanted at our institution. A Kaplan-Meier survival analysis for the endpoints exchange, addition or removal of any component for any reason, revision due to aseptic loosening and mechanical failure was performed. Radiological long-term (>ten years) follow-up (FU) analysis was performed according to the Knee Society Radiographic Evaluation and Scoring System. Mean age at surgery was 74.3 years, 28 % were male, and 89 % had primary osteoarthritis as diagnosis. Mean FU for survival analysis was 10.9 years (SD 4.2). A total of 58 % of the patients died during follow-up. Three patients (2.1 %) were lost to follow-up and five TKA (3.1 %) were revised. After ten years the mean survival was 97.7 %, 99.4 % and 98.3 % for the aforementioned endpoints, respectively. Mean radiological FU was 11.8 years (SD 2.3). We found no significant change in alignment of the components or axis over time. Progressive radiolucencies were found in nine TKA (17 %), mainly around the tibial component (95 %). The Duracon TKA showed excellent long-term survival comparable to data from national registers and to other successful designs. Radiological changes found on plain radiographs were scarce after almost 12 years of radiological follow-up indicating good implant stability.
    Full-text · Article · Nov 2013 · International Orthopaedics
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    • "In 2008 over 650,000 TKAs were performed in the U.S. at a cost of $9 billion (Kurtz et al. 2011; Cram et al. 2012). The prevalence of TKA is projected to increase to 3.5 million annually if growth rates remain constant as they have in the last 15 years (Kurtz et al. 2011). Despite success as a treatment of osteoarthritis TKA leaves patients with persistent muscle atrophy and loss of function. "
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    ABSTRACT: Total knee arthroplasty (TKA) is the most common remediation for knee pain from osteoarthritis (OA) and is performed 650,000 annually in the U.S. A tourniquet is commonly used during TKA which causes ischemia and reperfusion (I/R) to the lower limb but the effects of I/R on muscle are not fully understood. Previous reports suggest upregulation of cell-stress and catabolism and downregulation of markers of cap-dependent translation during and after TKA. I/R has also been shown to cause endoplasmic reticulum (ER) stress and induce the unfolded protein response (UPR). We hypothesized that the UPR would be activated in response to ER stress during TKA. We obtained muscle biopsies from the vastus lateralis at baseline, before TKA; at maximal ischemia, prior to tourniquet deflation; and during reperfusion in the operating room. Phosphorylation of 4E-BP1 and AKT decreased during ischemia (-28%, p < .05; -20%, p < .05 respectively) along with an increase in eIF2α phosphorylation (64%, p < .05) suggesting decreased translation initiation. Cleaved ATF6 protein increased in ischemia (39%, p = .056) but returned to baseline during reperfusion. CASP3 activation increased during reperfusion compared to baseline (23%, p < .05). XBP1 splicing assays revealed an increase in spliced transcript during ischemia (31%, p < .05) which diminished during reperfusion. These results suggest that in response to I/R during TKA all three branches of the ER stress response are activated.
    Full-text · Article · Aug 2013
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    • "Patients receiving a total knee arthroplasty (TKA) nowadays are heavier, more active, younger and have a longer life expectancy than those from previous decades [1]. Since these factors are associated with increased polyethelene (PE) wear, a higher number of revisions for wear may be expected [2, 3]. For these reasons there is a growing interest in factors that are associated with increased wear [4]. "
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    ABSTRACT: The aim of this observational study was to investigate the optimal minimal polyethylene (PE) thickness in total knee arthroplasty (TKA) and identify other risk factors associated with revision of the insert due to wear. A total of 84 TKA were followed for 11-16 years. All patients received the same prosthesis design (Interax; Howmedica/ Stryker) with halfbearings: separate PE-inserts medially and laterally. Statistical analysis comprised Cox-regression to correct for confounding. Eight knees (9.5%) had been revised due to thinning inserts and an additional patient is scheduled for revision. PE thickness, diagnosis, BMI and weight are risk factors for insert exchange. For each millimetre decrease in PE thickness, the risk of insert exchange increases 3.0 times, which remains after correction for age, gender, weight, diagnosis and femoral-tibial angle. Insert exchange was 4.73 times more likely in OA-patients compared to RA-patients. For every unit increase in BMI and weight the risk for insert exchange increases 1.40 times and 1.14 times, respectively. In conclusion we therefore advise against the use of thin PE inserts in modular TKA and recommend PE inserts with a minimal 8-mm thickness.
    Full-text · Article · Nov 2011 · International Orthopaedics
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