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Elena Losina - One of the best experts on this subject based on the ideXlab platform.
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estimating the burden of total Knee Replacement in the united states
Journal of Bone and Joint Surgery American Volume, 2013Co-Authors: Alexander M Weinstein, Jeffrey N Katz, John Wright, Benjamin N Rome, William M Reichmann, Jamie E Collins, Sara A Burbine, Thomas S Thornhill, Elena LosinaAbstract:Background: In the last decade, the number of total Knee Replacements performed annually in the United States has doubled, with disproportionate increases among younger adults. While total Knee Replacement is a highly effective treatment for end-stage Knee osteoarthritis, total Knee Replacement recipients can experience persistent pain and severe complications. We are aware of no current estimates of the prevalence of total Knee Replacement among adults in the U.S. Methods: We used the Osteoarthritis Policy Model, a validated computer simulation model of Knee osteoarthritis, and data on annual total Knee Replacement utilization to estimate the prevalence of primary and revision total Knee Replacement among adults fifty years of age or older in the U.S. We combined these prevalence estimates with U.S. Census data to estimate the number of adults in the U.S. currently living with total Knee Replacement. The annual incidence of total Knee Replacement was derived from two longitudinal Knee osteoarthritis cohorts and ranged from 1.6% to 11.9% in males and from 2.0% to 10.9% in females. Results: We estimated that 4.0 million (95% confidence interval [CI]: 3.6 million to 4.4 million) adults in the U.S. currently live with a total Knee Replacement, representing 4.2% (95% CI: 3.7% to 4.6%) of the population fifty years of age or older. The prevalence was higher among females (4.8%) than among males (3.4%) and increased with age. The lifetime risk of primary total Knee Replacement from the age of twenty-five years was 7.0% (95% CI: 6.1% to 7.8%) for males and 9.5% (95% CI: 8.5% to 10.5%) for females. Over half of adults in the U.S. diagnosed with Knee osteoarthritis will undergo a total Knee Replacement. Conclusions: Among older adults in the U.S., total Knee Replacement is considerably more prevalent than rheumatoid arthritis and nearly as prevalent as congestive heart failure. Nearly 1.5 million of those with a primary total Knee Replacement are fifty to sixty-nine years old, indicating that a large population is at risk for costly revision surgery as well as possible long-term complications of total Knee Replacement. Clinical Relevance: These prevalence estimates will be useful in planning health services specific to the population living with total Knee Replacement.
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epidemiology of total Knee Replacement in the united states medicare population
Journal of Bone and Joint Surgery American Volume, 2005Co-Authors: Nizar N Mahomed, Jane Barrett, Jeffrey N Katz, John A Baron, John Wright, Elena LosinaAbstract:Background: There are limited population-based data on the utilization and outcomes of total Knee Replacement. The aim of the present study was to describe the rates of primary and revision total Knee Replacement and selected outcomes in persons older than sixty-five years of age in the United States. Methods: Using Medicare claims, we computed annual incidence rates of unilateral elective primary and revision total Knee Replacement among United States Medicare beneficiaries in the year 2000. Poisson regression was used to assess the relationships between demographic characteristics and the incidence rates of primary and revision Knee Replacement. Proportional hazards models were used to examine the relationships between the ninety-day rates of complications and demographic and clinical factors. Results: The rate of primary Knee Replacement was lower in blacks than in whites and in those qualifying for Medicaid supplementation than in those with higher incomes. The complications observed during the ninety days following primary Knee Replacement included mortality (0.7%), readmission (0.9%), pulmonary embolus (0.8%), wound infection (0.4%), pneumonia (1.4%), and myocardial infarction (0.8%). The complications observed during the ninety days following revision Knee Replacement were mortality (1.1%), readmission (4.7%), pulmonary embolus (0.5%), wound infection (1.8%), pneumonia (1.4%), and myocardial infarction (1.0%). Blacks had higher rates of mortality, readmission, and wound infection after primary Knee Replacement than whites did. Patients who qualified for Medicaid supplementation had higher complication rates, particularly after primary Knee Replacement. Conclusions: Overall, the rates of postoperative complications during the ninety days following total Knee Replacement are low. In the United States, blacks and individuals with low income undergo total Knee Replacement less frequently and generally have higher rates of adverse outcomes following primary Knee Replacement. Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.
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association between hospital and surgeon procedure volume and the outcomes of total Knee Replacement
Journal of Bone and Joint Surgery American Volume, 2004Co-Authors: Jeffrey N Katz, Nizar N Mahomed, Jane Barrett, John A Baron, John R Wright, Elena LosinaAbstract:Background: The annual volume of major cardiovascular and oncologic procedures performed in hospitals and by surgeons has been inversely associated with the rates of perioperative mortality and complications. The relationship between hospital and surgeon volume and perioperative outcomes following total Knee Replacement has received little study. Methods: We analyzed claims data for Medicare patients who had elective primary total Knee Replacement between January 1 and August 31, 2000. Hospital and surgeon volumes were defined as the number of primary and revision total Knee Replacements performed in the hospital or by the surgeon in Medicare recipients in 2000. We examined the associations between the annual volumes of total Knee Replacement performed in the hospitals and by the surgeons and the rates of mortality and complications (infection, pulmonary embolus, myocardial infarction, or pneumonia) in the first ninety days postoperatively. The analyses were adjusted for age, gender, comorbid conditions, Medicaid eligibility (a marker of low income), and arthritis diagnosis. Analyses of hospital volume were adjusted for surgeon volume and vice versa. Results: Twenty-five percent of the primary total Knee Replacements were done by surgeons who performed twelve of these procedures or fewer in the Medicare population annually, and 11% were done in hospitals with an annual volume of twenty-five of these procedures or fewer. Compared with the patients who had a primary total Knee Replacement in hospitals with an annual volume of twenty-five procedures or fewer, those managed in hospitals with an annual volume exceeding 200 procedures had a lower risk of pneumonia (odds ratio, 0.65; 99% confidence interval, 0.47 to 0.90) and any of the adverse outcomes examined (death, pneumonia, pulmonary embolus, acute myocardial infarction, or deep infection) (odds ratio, 0.74; 99% confidence interval, 0.60 to 0.90). Similarly, patients who had a primary total Knee Replacement done by surgeons who performed more than fifty such procedures in Medicare recipients annually had a lower risk of pneumonia (odds ratio, 0.72; 99% confidence interval, 0.54 to 0.95) and any adverse outcome (odds ratio, 0.81; 99% confidence interval, 0.68 to 0.98) compared with patients of surgeons with an annual volume of twelve procedures or fewer. Conclusions: Patients managed at hospitals and by surgeons with greater volumes of total Knee Replacement have lower risks of perioperative adverse events following primary total Knee Replacement. Patients and clinicians should incorporate these findings into discussions about selecting a surgeon and a hospital for total Knee Replacement. These data should also be integrated into the policy debate about the advantages and drawbacks of regionalizing total joint Replacement to high-volume centers. Level of Evidence: Prognostic study, Level II-1 (retrospective study). See Instructions to Authors for a complete description of levels of evidence.
Jeffrey N Katz - One of the best experts on this subject based on the ideXlab platform.
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estimating the burden of total Knee Replacement in the united states
Journal of Bone and Joint Surgery American Volume, 2013Co-Authors: Alexander M Weinstein, Jeffrey N Katz, John Wright, Benjamin N Rome, William M Reichmann, Jamie E Collins, Sara A Burbine, Thomas S Thornhill, Elena LosinaAbstract:Background: In the last decade, the number of total Knee Replacements performed annually in the United States has doubled, with disproportionate increases among younger adults. While total Knee Replacement is a highly effective treatment for end-stage Knee osteoarthritis, total Knee Replacement recipients can experience persistent pain and severe complications. We are aware of no current estimates of the prevalence of total Knee Replacement among adults in the U.S. Methods: We used the Osteoarthritis Policy Model, a validated computer simulation model of Knee osteoarthritis, and data on annual total Knee Replacement utilization to estimate the prevalence of primary and revision total Knee Replacement among adults fifty years of age or older in the U.S. We combined these prevalence estimates with U.S. Census data to estimate the number of adults in the U.S. currently living with total Knee Replacement. The annual incidence of total Knee Replacement was derived from two longitudinal Knee osteoarthritis cohorts and ranged from 1.6% to 11.9% in males and from 2.0% to 10.9% in females. Results: We estimated that 4.0 million (95% confidence interval [CI]: 3.6 million to 4.4 million) adults in the U.S. currently live with a total Knee Replacement, representing 4.2% (95% CI: 3.7% to 4.6%) of the population fifty years of age or older. The prevalence was higher among females (4.8%) than among males (3.4%) and increased with age. The lifetime risk of primary total Knee Replacement from the age of twenty-five years was 7.0% (95% CI: 6.1% to 7.8%) for males and 9.5% (95% CI: 8.5% to 10.5%) for females. Over half of adults in the U.S. diagnosed with Knee osteoarthritis will undergo a total Knee Replacement. Conclusions: Among older adults in the U.S., total Knee Replacement is considerably more prevalent than rheumatoid arthritis and nearly as prevalent as congestive heart failure. Nearly 1.5 million of those with a primary total Knee Replacement are fifty to sixty-nine years old, indicating that a large population is at risk for costly revision surgery as well as possible long-term complications of total Knee Replacement. Clinical Relevance: These prevalence estimates will be useful in planning health services specific to the population living with total Knee Replacement.
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epidemiology of total Knee Replacement in the united states medicare population
Journal of Bone and Joint Surgery American Volume, 2005Co-Authors: Nizar N Mahomed, Jane Barrett, Jeffrey N Katz, John A Baron, John Wright, Elena LosinaAbstract:Background: There are limited population-based data on the utilization and outcomes of total Knee Replacement. The aim of the present study was to describe the rates of primary and revision total Knee Replacement and selected outcomes in persons older than sixty-five years of age in the United States. Methods: Using Medicare claims, we computed annual incidence rates of unilateral elective primary and revision total Knee Replacement among United States Medicare beneficiaries in the year 2000. Poisson regression was used to assess the relationships between demographic characteristics and the incidence rates of primary and revision Knee Replacement. Proportional hazards models were used to examine the relationships between the ninety-day rates of complications and demographic and clinical factors. Results: The rate of primary Knee Replacement was lower in blacks than in whites and in those qualifying for Medicaid supplementation than in those with higher incomes. The complications observed during the ninety days following primary Knee Replacement included mortality (0.7%), readmission (0.9%), pulmonary embolus (0.8%), wound infection (0.4%), pneumonia (1.4%), and myocardial infarction (0.8%). The complications observed during the ninety days following revision Knee Replacement were mortality (1.1%), readmission (4.7%), pulmonary embolus (0.5%), wound infection (1.8%), pneumonia (1.4%), and myocardial infarction (1.0%). Blacks had higher rates of mortality, readmission, and wound infection after primary Knee Replacement than whites did. Patients who qualified for Medicaid supplementation had higher complication rates, particularly after primary Knee Replacement. Conclusions: Overall, the rates of postoperative complications during the ninety days following total Knee Replacement are low. In the United States, blacks and individuals with low income undergo total Knee Replacement less frequently and generally have higher rates of adverse outcomes following primary Knee Replacement. Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.
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association between hospital and surgeon procedure volume and the outcomes of total Knee Replacement
Journal of Bone and Joint Surgery American Volume, 2004Co-Authors: Jeffrey N Katz, Nizar N Mahomed, Jane Barrett, John A Baron, John R Wright, Elena LosinaAbstract:Background: The annual volume of major cardiovascular and oncologic procedures performed in hospitals and by surgeons has been inversely associated with the rates of perioperative mortality and complications. The relationship between hospital and surgeon volume and perioperative outcomes following total Knee Replacement has received little study. Methods: We analyzed claims data for Medicare patients who had elective primary total Knee Replacement between January 1 and August 31, 2000. Hospital and surgeon volumes were defined as the number of primary and revision total Knee Replacements performed in the hospital or by the surgeon in Medicare recipients in 2000. We examined the associations between the annual volumes of total Knee Replacement performed in the hospitals and by the surgeons and the rates of mortality and complications (infection, pulmonary embolus, myocardial infarction, or pneumonia) in the first ninety days postoperatively. The analyses were adjusted for age, gender, comorbid conditions, Medicaid eligibility (a marker of low income), and arthritis diagnosis. Analyses of hospital volume were adjusted for surgeon volume and vice versa. Results: Twenty-five percent of the primary total Knee Replacements were done by surgeons who performed twelve of these procedures or fewer in the Medicare population annually, and 11% were done in hospitals with an annual volume of twenty-five of these procedures or fewer. Compared with the patients who had a primary total Knee Replacement in hospitals with an annual volume of twenty-five procedures or fewer, those managed in hospitals with an annual volume exceeding 200 procedures had a lower risk of pneumonia (odds ratio, 0.65; 99% confidence interval, 0.47 to 0.90) and any of the adverse outcomes examined (death, pneumonia, pulmonary embolus, acute myocardial infarction, or deep infection) (odds ratio, 0.74; 99% confidence interval, 0.60 to 0.90). Similarly, patients who had a primary total Knee Replacement done by surgeons who performed more than fifty such procedures in Medicare recipients annually had a lower risk of pneumonia (odds ratio, 0.72; 99% confidence interval, 0.54 to 0.95) and any adverse outcome (odds ratio, 0.81; 99% confidence interval, 0.68 to 0.98) compared with patients of surgeons with an annual volume of twelve procedures or fewer. Conclusions: Patients managed at hospitals and by surgeons with greater volumes of total Knee Replacement have lower risks of perioperative adverse events following primary total Knee Replacement. Patients and clinicians should incorporate these findings into discussions about selecting a surgeon and a hospital for total Knee Replacement. These data should also be integrated into the policy debate about the advantages and drawbacks of regionalizing total joint Replacement to high-volume centers. Level of Evidence: Prognostic study, Level II-1 (retrospective study). See Instructions to Authors for a complete description of levels of evidence.
Deborah A. Freund - One of the best experts on this subject based on the ideXlab platform.
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patient outcomes after Knee Replacement
Clinical Orthopaedics and Related Research, 1998Co-Authors: David A. Heck, Rebecca L Robinson, Cynthia M Partridge, Robert M Lubitz, Deborah A. FreundAbstract:A prospective, observational cohort investigation was performed to help understand the impact of Knee Replacement on patients with Knee osteoarthritis in community practice. Of those, 291 patients (330 Knees) were eligible and willing to participate. Forty-eight orthopaedic surgeons referred 563 patients from 25 institutions within the state of Indiana. Demographics, patient completed health status, satisfaction, independent radiographic measures, surgeon reported intraoperative factors, hospital discharge factors, and independent physical examinations were recorded. A minimum 2-year followup was obtained in 92% of the patients. At followup, 88% were satisfied, 3% were neutral, and 9% were dissatisfied with the results of their Knee surgery. The physical composite score improved from 27.4 ± 0.4 (range, 13.3-50.3) to 37.7 ± 0.7 (range, 12.9-61.3) at two years. Maximal improvement in physical composite score was seen in patients who had their surgery performed in institutions that performed greater than 50 Knee Replacements per year in patients with Medicare insurance; who had a better mental health status at baseline; who had surgery performed on Monday, Friday, or Saturday; who were older; who were treated with a posterior cruciate sparing device; and who had worse preoperative function. A lower likelihood of complications were found with surgeons who performed greater than 20 Knee Replacements per year; midweek surgeries; in patients with more severe preoperative Knee dysfunction; patients with fewer comorbidities; patients with less preoperative stiffness; patients being treated by younger surgeons; and in patients undergoing unilateral Knee Replacement. Among voluntarily participating physicians, Knee Replacement can be a highly effective medical technology with high levels of patient satisfaction and low rates of complications.
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REVISION RATES AFTER Knee Replacement IN THE UNITED STATES
Medical Care, 1998Co-Authors: David A. Heck, Catherine A. Melfi, Lorri A. Mamlin, Barry P. Katz, Daniel S. Arthur, Robert S. Dittus, Deborah A. FreundAbstract:Objectives. Each year approximately 100,000 Medicare patients undergo Knee Replacement surgery. Patients, referring physicians, and surgeons must consider a variety of factors when deciding if Knee Replacement is indicated. One factor in this decision process is the likelihood of revision Knee Replacement after the initial surgery. This study determined the chance that a revision Knee Replacement will occur and which factors were associated with revision. Methods. Data on all primary and revision Knee Replacements that were performed on Medicare patients during the years 1985 through 1990 were obtained. The probability that a revision Knee Replacement occurred was modeled from data for all patients for whom 2 full years of follow-up data were available. Two strategies for linking revisions to a particular primary Knee Replacement for each patient were developed. Predictive models were developed for each linking strategy. ICD-9-CM codes were used to determine hospitalizations for primary Knee Replacement and revision Knee Replacement. Results. More than 200,000 hospitalizations for primary Knee Replacements were performed, with fewer than 3% of them requiring revision within 2 years. The following factors increase the chance of revision within 2 years of primary Knee Replacement: (1) male gender, (2) younger age, (3) longer length of hospital stay for the primary Knee Replacement, (4) more diagnoses at the primary Knee Replacement hospitalization, (5) unspecified arthritis type, (6) surgical complications during the primary Knee Replacement hospitalization, and (7) primary Knee Replacement performed at an urban hospital. Conclusions. Revision Knee Replacement is uncommon. Demographic, clinical, and process factors were related to the probability of revision Knee Replacement.
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health related quality of life after Knee Replacement results of the Knee Replacement patient outcomes research team study
Journal of Bone and Joint Surgery American Volume, 1998Co-Authors: Gillian A Hawker, David A. Heck, Barry P. Katz, Robert S. Dittus, James G Wright, Peter C Coyte, John E Paul, Ruth Croxford, Claire Bombardier, Deborah A. FreundAbstract:A cross-sectional, community-based survey of a random sample of 1750 of 242,311 Medicare recipients was performed. The patients were at least sixty-five years old and had had a primary or revision Knee Replacement (either unilaterally or bilaterally) between 1985 and 1989. Three samples were surveyed separately: a national sample (to reflect the United States as a whole) and samples from Indiana and the western part of Pennsylvania (sites chosen for convenience to assess the validity of the findings for the national sample on a regional level). Each sample was stratified by race, age, residence (urban or rural), and the year of the procedure. Valid and reliable questionnaires were used to elicit the participants' assessments of pain, physical function, and satisfaction two to seven years after the Knee Replacement. Of the 1486 patients who were eligible for inclusion in the survey, 1193 (80.3 per cent) responded. The mean age of the respondents was 72.6 years. Eight hundred and forty-nine respondents (71.2 per cent) were white, and 849 (71.2 per cent) were women. The participants reported that they had little or no pain in the Knee at the time of the survey, regardless of the age at the time of the Knee Replacement, the body-mass index, or the length of time since the Knee Replacement. After adjustment for potential confounding variables, predictors of better physical function after the Replacement were an absence of problems with the contralateral Knee, primary Knee Replacement (rather than revision) (Indiana sample only), and a lower body-mass index (Indiana and western Pennsylvania samples). Four hundred and fifteen (85.2 per cent) of the 487 patients in the national sample were satisfied with the result of the Knee Replacement. In what we believe to be the first community-based study of the outcome of Knee Replacement, patients reported having significant (p = 0.0001) and persistent relief of pain, improved physical function, and satisfaction with the result two to seven years postoperatively. The findings of the present study suggest that age and obesity do not have a negative impact on patient-relevant outcomes (pain and physical function). Dissemination of these findings has the potential to increase appropriate referrals for Knee Replacement and thereby reduce the pain and functional disability due to osteoarthrosis of the Knee.
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Tricompartmental Knee Replacement. A comparison of orthopaedic surgeons' self reported performance rates with surgical indications, contraindications, and expected outcomes. Knee Replacement Patient Outcomes Research Team.
Clinical Orthopaedics and Related Research, 1994Co-Authors: William M. Tierney, David A. Heck, Catherine A. Melfi, Barry P. Katz, John F. Fitzgerald, Kennedy Jm, R. S. Dittus, Deborah I. Allen, Deborah A. FreundAbstract:The chance of a person with osteoarthritis of the Knee receiving a Knee Replacement is highly variable. To understand better the reasons for this variation, all practicing orthopaedists in Indiana were surveyed about their management of severe Knee osteoarthritis and their perception of tricompartmental Knee Replacement as a therapeutic option. Their perceptions of indications and outcomes of Knee Replacement were compared with the self reported annual number of patients for whom they performed (or referred to other surgeons for) tricompartmental Knee Replacements. A completed survey was returned by 220 (79%) of the 280 orthopaedists surveyed; analyses were limited to the 188 respondents who had cared for at least one patient with osteoarthritis of the Knee in the prior 2 weeks (mean = 13). These surgeons reported performing (or referring patients for) a mean of 31 Knee Replacements in the prior year (SD 45, median 21, range 0-480 Knee Replacements). There was strong agreement (> 95%) among respondents for seven (21%) of 33 surgical indications and contraindications, and more general agreement (> 60%) for 21 (64%). In the five factors (15%) for which there was disagreement, there was no consistent relationship between opinions and self reported Knee Replacement performance rate. Surgeons reporting more Knee Replacements had significantly higher estimates of pain relief and functional improvement following surgery, and lower estimates of prosthesis infection and failure rates. When all responses were considered together, four decision factors correlated independently with the performance of more Knee Replacements, but these four factors explained only 24% of the variation in self reported Knee Replacement performance.(ABSTRACT TRUNCATED AT 250 WORDS)
D W Murray - One of the best experts on this subject based on the ideXlab platform.
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Lifetime revision risk for medial unicompartmental Knee Replacement is lower than expected
Knee Surgery Sports Traumatology Arthroscopy, 2020Co-Authors: J. A. Kennedy, E. Burn, H. R. Mohammad, S. J. Mellon, A. Judge, D W MurrayAbstract:Purpose Unicompartmental Knee Replacement (UKR) is widely considered to be a pre-total Knee Replacement (TKR) particularly in the young. The implication of this is that it is sensible to do a UKR, even though it will be revised at some stage, as it will delay the need for a TKR. The chance of a UKR being revised during a patient’s life time has not previously been calculated. The aim of this study was to estimate this lifetime revision risks for patients of different ages undergoing UKR. Methods Calculations were based on data from a designer series of 1000 medial Oxford UKR with mean 10-year follow up. These UKR were implanted for the recommended indications using the recommended surgical technique. Parametric survival models were developed for patients of different ages based on observed data, and were extrapolated using a Markov model to estimate lifetime revision risk. Results The estimated lifetime revision risk reduced with increasing age at surgery. Lifetime revision risk at age 55 was 15% (95% CI 12–19), at 65 it was 11% (8–13), at 75 it was 7% (5–9), and at 85 it was 4% (3–5). Conclusion Provided UKR is used appropriately, the lifetime revision risk is markedly lower than expected. UKR should be considered to be a definitive Knee Replacement rather than a Pre-TKR even in the young. These lifetime estimates, alongside established benefits for UKR in speed of recovery, morbidity, mortality and function, can be discussed with appropriate patients when considering whether to implant a UKR or TKR. Level of evidence III.
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Revision of unicondylar Knee Replacements to total Knee Replacement
Knee, 1995Co-Authors: Jg Martin, D A Wallace, D A Woods, Andrew Carr, D W MurrayAbstract:Abstract The outcome of 23 Oxford unicondylar Knee Replacements revised to total Knee Replacements was assessed with an average follow up of 4.1 years. At revision, 30% of the cases had required reconstruction for bone deficiency. Bone graft, when needed, was obtained from the revision cuts. One patient required re-revision for recurrent sepsis. The remainder included 10 excellent, 3 good, 2 fair and 2 poor results. The poor results were because of instability which could have been prevented by using a more constrained implant. Revision of unicondylar Knee Replacement is technically easier and results superior to the revision of total Knee Replacement.
Daniel J Berry - One of the best experts on this subject based on the ideXlab platform.
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prevalence of total hip and Knee Replacement in the united states
Journal of Bone and Joint Surgery American Volume, 2015Co-Authors: Hilal Maradit Kremers, Dirk R Larson, Cynthia S Crowson, Walter K Kremers, Raynard Washington, Claudia Steiner, William A Jiranek, Daniel J BerryAbstract:The incidence of joint Replacement procedures is high, with over 1 million total hip and total Knee Replacement procedures performed each year in the United States1. With the aging of the “baby boomers,” higher rates of diagnosis and treatment of advanced arthritis, and growing demand for improved mobility and quality of life, the annual procedure volumes are projected to increase considerably in the future, making joint Replacements the most common elective surgical procedures in the coming decades2,3. Such a large increase in demand is unprecedented and must be addressed with effective planning of health-care services for these individuals, not only during the perioperative period but throughout the lifelong continued care of this population. To date, studies involving the descriptive epidemiology of total hip and total Knee Replacement have focused almost exclusively on annual procedure volumes (i.e., incidence)2-9. Although incidence data are informative, they offer an incomplete assessment of the impact of total hip and total Knee Replacement on the population and the health-care system. The prevalence of individuals who are currently living with an artificial hip or Knee joint in the United States is currently unknown. Indeed, the increasing use of joint Replacement in younger individuals, coupled with improvements in life expectancy, has created a large pool of individuals with hip and Knee Replacements in the United States2,10. These individuals not only have specialized needs, but in some cases, will outlive their implants and require expensive revision surgeries with substantial implications related to cost and resource use. Therefore, estimates of prevalence are vital to agencies charged with planning for the provision of health-care services for these individuals. We know of only one study to date that has provided prevalence estimates of total Knee Replacement11, but the methodology used to estimate prevalence was based on a computer-simulation model of the natural history of osteoarthritis and did not take into account the substantial increase in procedure volumes in recent years5. Therefore, we sought to estimate the current prevalence and historical trends in the prevalence of total hip and total Knee Replacement in the United States using multiple data sources and accounting for the secular increase in procedure volumes in recent years.
