A population-based study of trends in the use of total hip and total knee arthroplasty, 1969-2008.
OBJECTIVE
To study the rates of use of total hip arthroplasty (THA) and total knee arthroplasty (TKA) during the past 4 decades.


METHODS
The Rochester Epidemiology Project was used to identify all Olmsted County, Minnesota, residents who underwent THA or TKA from January 1, 1969, through December 31, 2008. We used a population-based approach because few data are available on long-term trends in the use of THA and TKA in the United States. Rates of use were determined by age- and sex-specific person-years at risk. Poisson regression was used to assess temporal trends by sex and age group.


RESULTS
The age- and sex-adjusted use of THA increased from 50.2 (95% confidence interval [CI], 40.5-59.8) per 100,000 person-years in 1969-1972 to 145.5 (95% CI, 134.2-156.9) in 2005-2008, whereas TKA increased markedly from 31.2 (95% CI, 25.3-37.1) per 100,000 person-years in 1971-1976 to 220.9 (95% CI, 206.7-235.0) in 2005-2008. For both procedures, use was greater among females, and the rate generally increased with age.


CONCLUSIONS
In this community, TKA and THA use rates have increased steadily since the introduction of the procedures and continue to increase for all age groups. On the basis of these population-based data, the probable need for TKA and THA exceeds current federal agency projections.
Singh
Jasvinder A
JA
Department of Orthopedic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
Vessely
Michael B
MB
Harmsen
W Scott
WS
Schleck
Cathy D
CD
Melton
L Joseph
LJ
Kurland
Robert L
RL
Berry
Daniel J
DJ
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000639:trends*; D019645:Arthroplasty, Replacement, Knee / Q000639:trends*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D015207:Osteoarthritis, Hip / Q000453:epidemiology / Q000601:surgery*; D020370:Osteoarthritis, Knee / Q000453:epidemiology / Q000601:surgery*; D011159:Population Surveillance / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D017678:Sex Distribution; D055815:Young Adult
Arthritis Rheum. 2002 Sep;46(9):2429-35
12355491
N Engl J Med. 1997 Nov 13;337(20):1466-70
9380105
Med Care. 2002 Jan;40(1 Suppl):I44-51
11789631
Mayo Clin Proc. 1991 Jun;66(6):589-95
2046396
J Bone Joint Surg Am. 1990 Dec;72(10):1470-6
2254354
Arch Intern Med. 2005 Jul 25;165(14):1593-8
16043676
Semin Arthritis Rheum. 1990 Dec;20(3 Suppl 1):34-41
2287947
Mayo Clin Proc. 1996 Mar;71(3):266-74
8594285
Med Care. 2003 Feb;41(2):288-98
12555056
Health Serv Res. 1996 Jun;31(2):125-40
8675435
Med Care. 2001 Mar;39(3):206-16
11242316
Clin Orthop Relat Res. 1998 Nov;(356):22-7
9917663
JAMA. 1996 Mar 20;275(11):858-65
8596224
Int J Qual Health Care. 2005 Aug;17(4):315-21
15879010
Int J Technol Assess Health Care. 2000 Winter;16(1):165-77
10815362
J Bone Joint Surg Am. 2005 Jul;87(7):1487-97
15995115
NIH Consens State Sci Statements. 2003 Dec 8-10;20(1):1-34
17308549
Med Care. 2002 Jun;40(6):451-60
12021671
Knee. 2007 Jan;14(1):9-11
17169563
Med Care. 2002 Jun;40(6):447-50
12021670
Mayo Clin Proc. 2001 Dec;76(12):1199-203
11761500
JAMA. 1994 May 4;271(17):1349-57
8158821
Acta Orthop. 2005 Feb;76(1):28-41
15788305
Arthritis Rheum. 2002 Mar;46(3):625-31
11920397
Arthritis Rheum. 2005 Dec 15;53(6):979-81
16342110
Arthritis Rheum. 2009 Dec 15;61(12):1677-85
19950319
Arthritis Rheum. 2010 Jun;62(6):1576-82
20191579
Mayo Clin Proc. 1993 Jan;68(1):11-8
8417249
J Bone Joint Surg Am. 2003 Feb;85(2):259-65
12571303
J Bone Joint Surg Am. 2007 Apr;89(4):780-5
17403800
Health Aff (Millwood). 1997 Sep-Oct;16(5):58-72
9314676
Acta Orthop. 2008 Dec;79(6):812-9
19085500
Ann Rheum Dis. 2010 May;69(5):868-71
19581279
Ethn Dis. 1994 Winter;4(1):57-67
7742733
J Bone Joint Surg Am. 1992 Dec;74(10):1530-9
1469013
J Clin Epidemiol. 1995 Apr;48(4):527-37
7722609
J Bone Joint Surg Am. 2005 Jun;87(6):1222-8
15930530
N Engl J Med. 2003 Oct 2;349(14):1350-9
14523144
Top Health Inf Manage. 2000 Nov;21(2):10-23
11143275
BMC Musculoskelet Disord. 2008 Oct 02;9:132
18831740