4 million living with total knee replacement (TKR): First estimates of TKR burden in the US

Feb 15th – 4 million or 4.2% of adults over 50 in the US are living with a TKR.  Over 500,000 have a revision TKR. 

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Image: PD

1. 4 million or 4.2% of adults over 50 in the US are living with a TKR.  Over 500,000 have a revision TKR.

2. 52.2% of males and 50.6% of females diagnosed with symptomatic knee osteoarthritis (SKOA) will receive a primary TKR before death.

According to this report, over one third of the 11 million adults in the US diagnosed with symptomatic knee osteoarthritis (SKOA) have a TKR.  Of them, over 500,000 had a revision due to complications such as infection, periprosthetic fracture, symptomatic implant loosening, or mechanical failure.  While TKR use has doubled over the past decade, it has tripled within the 45-64 year-old age group.  As the use of TKR in a younger and healthier population accelerates, the longevity required of those implants and subsequent risk of costly revision surgery will also grow.  In order to prepare for the significant public health burden these patients could impose, it is highly valuable to define the population of Americans living with TKR. This study is limited by its inherent extrapolation of data from restricted cohorts.  That said, the analysis was run based on conservative parameters.  This suggests that the results are an underestimate, further reinforcing their significance.

Click to read the study in JBJS

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Image: PD

1. 4 million or 4.2% of adults over 50 in the US are living with a TKR.  Over 500,000 have a revision TKR.

2. 52.2% of males and 50.6% of females diagnosed with (symptomatic knee osteoarthritis) SKOA will receive a primary TKR before death.

This study utilized the Osteoarthritis Policy Model (OAPol) to estimate the prevalence, incidence, and lifetime risk of total knee replacement (TKR) for adults 50 years and older living in the U.S.  OAPol is a validated computer simulation model of the natural history of symptomatic knee osteoarthritis (SKOA).   Inputs to the model included baseline demographics of age, sex, and BMI (from NHANES 2005-2008), the annual incidence and progression of SKOA, and the estimated use of standard non-surgical treatment regimens that may delay surgical intervention.  Two multi-center longitudinal observational studies – Multicenter Osteoarthritis Study [MOST] and the Osteoarthritis Initiative [OAI] were used in combination with U.S. Census data to derive the annual incidence of TKR.  All results were stratified by age and sex.

The prevalence of SKOA among adults age 50 and older in the U.S. is estimated at 11.5%.  Over one third of these, or 4.2% of this population, has a TKR.  Trends include increased prevalence of TKR with age and a higher risk for females than males (4.8% vs 3.4%).  The total number of Americans over 50 living with TKR is estimated at 4 million, of which over 500,000 have a revised TKR.  The lifetime risk of receiving a primary TKR is 7.0% for males and 9.5% for females.  Based on this data, 52.2% of males and 50.6% of females diagnosed with SKOA will receive a primary TKR before death.

In sum: According to this report, over one third of the 11 million adults in the US diagnosed with symptomatic knee osteoarthritis (SKOA) have a TKR.  Of them, over 500,000 had a revision due to complications such as infection, periprosthetic fracture, symptomatic implant loosening, or mechanical failure.  While TKR use has doubled over the past decade, it has tripled within the 45-64 year-old age group.  As the use of TKR in a younger and healthier population accelerates, the longevity required of those implants and subsequent risk of costly revision surgery will also grow.  In order to prepare for the significant public health burden these patients could impose, it is highly valuable to define the population of Americans living with TKR. This study is limited by its inherent extrapolation of data from restricted cohorts.  That said, the analysis was run based on conservative parameters.  This suggests that the results are an underestimate, further reinforcing their significance.

Click to read the study in JBJS

By Chaz Carrier and Allen Ho

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