title: The epidemiology of revision total knee and hip arthroplasty in England and Wales: a comparative analysis with projections for the United States. A study using the National Joint Registry dataset.
abstract: Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are recognised and proven interventions for patients with advanced arthritis. Studies to date have demonstrated a steady increase in the requirement for primary and revision procedures. Projected estimates made for the United States show that by 2030 the demand for primary TKA will grow by 673% and for revision TKA by 601% from the level in 2005. For THA the projected estimates are 174% and 137% for primary and revision surgery, respectively. The purpose of this study was to see if those predictions were similar for England and Wales using data from the National Joint Registry and the Office of National Statistics. Analysis of data for England and Wales suggest that by 2030, the volume of primary and revision TKAs will have increased by 117% and 332%, respectively between 2012 and 2030. The data for the United States translates to a 306% cumulative rate of increase between 2012 and 2030 for revision surgery, which is similar to our predictions for England and Wales. The predictions from the United States for primary TKA were similar to our upper limit projections. For THA, we predicted an increase of 134% and 31% for primary and revision hip surgery, respectively. Our model has limitations, however, it highlights the economic burden of arthroplasty in the future in England and Wales as a real and unaddressed problem. This will have significant implications for the provision of health care and the management of orthopaedic services in the future.
authors.affiliation: Royal Stoke University Hospital, Newcastle Road, Stoke on Trent, Staffordshire, ST4 6QG, UK.
authors.forename: A
authors.initials: A
authors.lastname: Patel
authors.affiliation: Wrightington Wigan and Leigh NHS Trust Wrightington Hospital, Hall Lane, Appley Bridge, Wigan WN6 9EP, UK.
authors.forename: G
authors.initials: G
authors.lastname: Pavlou
authors.affiliation: University of Exeter Medical School, Exeter, EX1 2LU, UK.
authors.forename: R E
authors.initials: RE
authors.lastname: Mújica-Mota
authors.affiliation: Exeter Knee Reconstruction Unit, Barrack Road, Exeter, EX2 5DW, UK.
authors.forename: A D
authors.initials: AD
authors.lastname: Toms
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data*; D019645:Arthroplasty, Replacement, Knee / Q000706:statistics & numerical data*; D004739:England / Q000453:epidemiology; D005544:Forecasting; D006801:Humans; D015207:Osteoarthritis, Hip / Q000453:epidemiology* / Q000601:surgery*; D020370:Osteoarthritis, Knee / Q000453:epidemiology* / Q000601:surgery*; D012042:Registries; D014852:Wales / Q000453:epidemiology
keywords: Epidemiology; Financial Burden; Total Hip Replacement; Total Knee Replacement