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Increase seen in prevalence of primary, revision TKA over 20 years

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Both primary and revision total knee arthroplasty procedures have increased during the past 20 years, in part because of an increase in Medicare enrollees and per capita utilization, according to Iowa researchers.

In 1991, the total number of total knee arthroplasty (TKA) procedures performed for Medicare patients was 93,230. In 2010, the number increased 161.5% to 243,802 procedures. Per capita utilization for TKA increased from 31.2 procedures per 10,000 enrollees in 1991 to 62.1 per 10,000 in 2010, a 99.2% increase.

“Trends in discharge disposition after revision TKA demonstrated a similar pattern to that which was observed for primary TKA, a decline in discharges to home or inpatient rehabilitation and an increase in discharge to skilled care and outpatient rehabilitation,” Peter Cram, MD, MBA, of the University of Iowa Carver College of Medicine in Iowa City, Iowa, and colleagues stated in a press release.

Similarly, revision procedures also increased, from 9,650 to 19,871, while per capita utilization for revision TKA increased from 3.2 to 5.1 procedures per 10,000 Medicare enrollees, according to the abstract.

“This growth is likely driven by a combination of factors including an expansion in the types of patients considered likely to benefit from TKA, an aging population and an increasing prevalence of certain conditions that predispose patients to osteoarthritis, most notably obesity,” Cram and colleagues stated in the study.

Reference:

Cram P, Lu X, Kates SL, et al. Total knee arthroplasty volume, utilization, and outcomes among Medicare beneficiaries, 1991-2010. JAMA. 2012;308(12)1227-1236. doi:10.1001/2012.jama.11153.

Disclosure: Cram is supported by a K24 award from NIAMS and by the Department of Veterans Affairs and is a paid consultant for The Consumers Union and Vanguard Health Inc.