title: International survey of primary and revision total knee replacement.
abstract: OBJECTIVE
  Total knee arthroplasty (TKA) is currently the international standard of care for treating degenerative and rheumatologic knee joint disease, as well as certain knee joint fractures. We sought to answer the following three research questions: (1) What is the international variance in primary and revision TKA rates around the world? (2) How do patient demographics (e.g., age, gender) vary internationally? (3) How have the rates of TKA utilization changed over time?
  
  
  METHODS
  The survey included 18 countries with a total population of 755 million, and an estimated 1,324,000 annual primary and revision total knee procedures. Ten national inpatient databases were queried for this study from Canada, the United States, Finland, France, Germany, Italy, the Netherlands, Portugal, Spain, and Switzerland. Inpatient data were also compared with published registry data for eight countries with operating arthroplasty registers (Denmark, England & Wales, Norway, Romania, Scotland, Sweden, Australia, and New Zealand).
  
  
  RESULTS
  The average and median rate of primary and revision (combined) total knee replacement was 175 and 149 procedures/100,000 population, respectively, and ranged between 8.8 and 234 procedures/100,000 population. We observed that the procedure rate significantly increased over time for the countries in which historical data were available. The compound annual growth in the incidence of TKA ranged by country from 5.3% (France) to 17% (Portugal). We observed a nearly 27-fold range of TKA utilization rates between the 18 different countries included in the survey.
  
  
  CONCLUSIONS
  It is apparent from the results of this study that the demand for TKA has risen substantially over the past decade in countries around the world.
authors.affiliation: Exponent, Inc., Philadelphia, PA 19104, USA. skurtz@exponent.com
authors.forename: Steven M
authors.initials: SM
authors.lastname: Kurtz
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Ong
authors.forename: Edmund
authors.initials: E
authors.lastname: Lau
authors.forename: Marcel
authors.initials: M
authors.lastname: Widmer
authors.forename: Milka
authors.initials: M
authors.lastname: Maravic
authors.forename: Enrique
authors.initials: E
authors.lastname: Gómez-Barrena
authors.forename: Maria de Fátima
authors.initials: Mde F
authors.lastname: de Pina
authors.forename: Valerio
authors.initials: V
authors.lastname: Manno
authors.forename: Marina
authors.initials: M
authors.lastname: Torre
authors.forename: William L
authors.initials: WL
authors.lastname: Walter
authors.forename: Richard
authors.initials: R
authors.lastname: de Steiger
authors.forename: Rudolph G T
authors.initials: RG
authors.lastname: Geesink
authors.forename: Mikko
authors.initials: M
authors.lastname: Peltola
authors.forename: Christoph
authors.initials: C
authors.lastname: Röder
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D014943:Global Health; D019538:Health Care Surveys; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D012042:Registries; D012086:Reoperation