Projections of Primary TKA and THA in Germany From 2016 Through 2040

Abstract

Background Future projections for both TKA and THA in the United States and other countries forecast a further increase of already high numbers of joint replacements. The consensus is that in industrialized countries, this increase is driven by demographic changes with more elderly people being less willing to accept activity limitations. Unlike the United States, Germany and many other countries face a population decline driven by low fertility rates, longer life expectancy, and immigration rates that cannot compensate for population aging. Many developing countries are likely to follow that example in the short or medium term amid global aging. Due to growing healthcare expenditures in a declining and aging population with a smaller available work force, reliable predictions of procedure volume by age groups are requisite for health and fiscal policy makers to maintain high standards in arthroplasty for the future population. Questions/purposes (1) By how much is the usage of primary TKA and THA in Germany expected to increase from 2016 through 2040? (2) How is arthroplasty usage in Germany expected to vary as a function of patient age during this time span? Methods The annual number of primary TKAs and THAs were calculated based on population projections and estimates of future healthcare expenditures as a percent of the gross domestic product (GDP) in Germany. For this purpose, a Poisson regression analysis using age, gender, state, healthcare expenditure, and calendar year as covariates was performed. The dependent variable was the historical number of primary TKAs and THAs performed as compiled by the German federal office of statistics for the years 2005 through 2016. Results Through 2040, the incidence rate for both TKA and THA will continue to increase annually. For TKA, the incidence rate is expected to increase from 245 TKAs per 100,000 inhabitants to 379 (297-484) (55%, 95% CI 21 to 98). The incidence rate of THAs is anticipated to increase from 338 to 437 (357-535) per 100,000 inhabitants (29% [95% CI 6 to 58]) between 2016 and 2040. The total number of TKAs is expected to increase by 45% (95% CI 14 to 8), from 168,772 procedures in 2016 to 244,714 (95% CI 191,920 to 312,551) in 2040. During the same period, the number of primary THAs is expected to increase by 23% (95% CI 0 to 50), from 229,726 to 282,034 (95% CI 230,473 to 345,228). Through 2040, the greatest increase in TKAs is predicted to occur in patients aged 40 to 69 years (40- to 49-year-old patients: 269% (95% CI 179 to 390); 50- to 59-year-old patients: 94% (95% CI 48 to 141); 60- to 69-year-old patients: 43% (95% CI 13 to 82). The largest increase in THAs is expected in the elderly (80- to 89-year-old patients (71% [95% CI 40 to 110]). Conclusions Although the total number of TKAs and THAs is projected to increase in Germany between now and 2040, the increase will be smaller than that previously forecast for the United States, due in large part to the German population decreasing over that time, while the American population increases. Much of the projected increase in Germany will be from the use of TKA in younger patients and from the use of THA in elderly patients. Knowledge of these trends may help planning by surgeons, hospitals, stakeholders, and policy makers in countries similar to Germany, where high incidence rates of arthroplasty, aging populations, and overall decreasing populations are present. Level of Evidence Level III, economic and decision analysis.

The projected volume of primary and revision total knee arthroplasty will place an immense burden on future health care systems over the next 30 years

“…Just recently, Rupp et al published their projections of primary TKA and total hip arthroplasty in Germany from 2016 through 2040 based on the same database. Using a Poisson approach with general health expenditures as additional covariate, they projected the total number of TKAs to rise by 45% until 2040, with the greatest increase being predicted to occur in patients aged 40-49 years (269%) [48]. These findings are strongly supported by the projections of the present investigation, with an average increase of 43% of primary TKA between 2018 and 2050.…”

Prevention at work needed to curb the worldwide strong increase in knee replacement surgery for working-age osteoarthritis patients

“…The largest increase in primary surgery demands is not among the classic knee arthroplasty population of patients aged 70 years and older, but among patients of working age ( 1 – 4 , 9 ). For instance, Germany – one of the leading countries in the prevalence of knee arthroplasty – foresees the highest increase in patients aged 50– 65 years until 2050 ( 10 ), and in a similar study using the same database even among patients aged 40–49 years until 2040 ( 11 ). In several countries, the current proportion of knee arthroplasty patients under 65 years is already substantial at 30–40%.…”

A retrospective analysis of trends in primary knee arthroplasty in Germany from 2008 to 2018

“…Intriguingly, also, the number of younger patients receiving primary knee arthroplasty is rising in the western population 3 – 6 . This development leads to high costs for the healthcare systems and to a consecutive increasing number of revision arthroplasties, which are burdensome for the patients 7 , 8 .…”

“…Estimations for the future development of primary knee arthroplasty in Germany over the next decades exist 7 . However, trends of different primary arthroplasty procedures during the recent years have to be elucidated.…”