Total knee arthroplasty in Italy: reflections from the last fifteen years and projections for the next thirty

Romanini, Emilio; Decarolis, Francesco; Luzi, Ilaria; Zanoli, Gustavo; Venosa, Michele; Laricchiuta, Paola; Carrani, E.; Torre, Marina

doi:10.1007/s00264-018-4165-7

Cited by 45 publications

(36 citation statements)

References 26 publications

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“…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. Similar trends and rates have also been reported for other European countries [5,40,47]. For the U.S. an even higher increase has been projected (+ 673% between 2005 and 2030) [28].…”

Section: Discussionsupporting

confidence: 80%

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

Klug

Gramlich

Rudert

et al. 2020

Knee Surg Sports Traumatol Arthrosc

203

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Purpose Total knee arthroplasty (TKA) rates have increased substantially in the recent decades worldwide, with Germany being one of the leading countries in the prevalence of TKA. The aim of this study was to provide an overview of treatment changes during the last decade and to project the expected burden of primary and revision TKA (rTKA) for the next 30 years. Methods Comprehensive nationwide data from Germany was used to quantify primary and revision TKA rates as a function of age and gender. Projections were performed with use of a Poisson regression models and a combination of exponential smoothing and autoregressive integrated moving average models on historical procedure rates in relation to official population projections from 2020 to 2050. Results The incidence rate of primary TKAs is projected to increase by around 43% to 299 per 100,000 inhabitants [95% CI 231-368], leading to a projected total number of 225,957 primary TKAs in 2050 (95% CI 178,804-276,442). This increase has been related to a growing number of TKA performed in male patients, with the highest increase modelled in patients between 50 and 65 years of age. At the same time, the annual total number of revision procedures is forecast to increase even more rapidly by almost 90%, accounting for 47,313 (95% CI 15,741-78,885; IR = 62.7 per 100,000, 95% CI 20.8-104.5) procedures by 2050. Those numbers are primarily associated with a rising number of rTKAs secondary to periprosthetic joint infection (PJI). Conclusions Using this country-specific forecast approach, a rising number of primary TKA and an even more rapidly growing number of rTKA, especially for PJI, has been projected until 2050, which will inevitably provide a huge challenge for the future health care system. As many other industrialized nations will face similar demographic and procedure-specific developments, these forecasts should be alarming for many health care systems worldwide and emphasize the tremendous need for an appropriate financial and human resource management in the future. Level of evidence Level III, prognostic study, economic and decision analysis.

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Section: Discussionsupporting

confidence: 80%

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

Klug

Gramlich

Rudert

et al. 2020

Knee Surg Sports Traumatol Arthrosc

203

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“…An absolute increase in knee replacement surgery of 297% – to 57 893 procedures – is forecasted in The Netherlands between 2005 and 2030 ( 1 ). The situation is similar in many countries: Sweden, 163% to 21 700 (2013–2030) ( 2 ); Italy, 45% to about 100 000 (2017–2050) ( 3 ), the UK, 916% to about 1.2 million (2015–2035) ( 4 ); Australia, 276% to 65 569 (2013–2030) ( 5 ); and the USA, 673% to 3.48 million (2005–2030) ( 6 ). No projections are available for Asia, however, similar growth percentages have already been seen in Japan of 373% (2007–2014) ( 7 ) and Korea (407%, 2001–2010) ( 8 ).…”

mentioning

confidence: 91%

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

Kuijer¹,

Burdorf²

2020

Scand J Work Environ Health

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Prevention at work needed to curb the worldwide strong increase in knee replacement surgery for working-age osteoarthritis patients In the upcoming decades, hospitals and clinics around the world face a steep rise in demand from patients seeking knee replacement surgery. An absolute increase in knee replacement surgery of 297%-to 57 893 procedures-is forecasted in The Netherlands between 2005 and 2030 (1). The situation is similar in many countries: Sweden, 163% to 21 700 (2013-2030) (2); Italy, 45% to about 100 000 (2017-2050) (3), the UK, 916% to about 1.2 million (2015-2035) (4); Australia, 276% to 65 569 (2013-2030) (5); and the USA, 673% to 3.48 million (2005-2030) (6). No projections are available for Asia, however, similar growth percentages have already been seen in Japan of 373% (2007-2014) (7) and Korea (407%, 2001-2010) (8). Knee replacement surgery or arthroplasty is the final treatment option for patients suffering from knee osteoarthritis (OA). These increasing numbers are alarming, not only due to the extreme high demands on healthcare provision and budgets, but also for the unforeseen impact on work participation. There is a lack of awareness how work might play a significant role in reducing the steep rise in replacement surgery for knee OA across the world. Unforeseen impact on work 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%. It is expected in 2030 that the USA will be the first country where the majority of these patients will be younger than 65 years (6), followed by the UK in 2035 (4). This increase in surgery and shift towards younger age groups can largely be explained by good clinical and cost-effective long-term outcomes, no clear threshold for surgery, and the rising number of younger and more demanding knee OA patients (9). Originally, knee arthroplasty was mainly aimed at reducing pain, improving knee function and thereby enhancing the performance of activities of daily life in the patient population aged 70 years and older. The current success was totally unforeseen by LG Shiers, the founding father of knee arthroplasty (12). In 1954, he concluded: "… few surgeons will ever see 50 patients requiring arthroplasty, let alone operate on them, even in five years". Nowadays, specialized orthopedic surgeons perform this procedure several times per day. Despite the good clinical outcomes, return to work is not that favorable after surgery. About two of every ten working-age patients are dissatisfied with their work ability due to their knee arthroplasty (13). The majority...

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“…The total number of surgeries increased by 262% with an average annual growth rate of 6.6%. Adopting the best fitting projection method, an increase of 45% in incidence rate is expected for 2050 [17].…”

Section: Kneementioning

confidence: 99%

The history of Italian Orthopaedics

Papalia

Falez

2018

International Orthopaedics (SICOT)

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Total knee arthroplasty in Italy: reflections from the last fifteen years and projections for the next thirty

Cited by 45 publications

References 26 publications

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

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

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

The history of Italian Orthopaedics

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