title: Changing trends of total knee replacement utilization over more than a decade.
abstract: BACKGROUND
  Osteoarthritis of the knee causes significant disability amongst the elderly, and total knee replacement remains the only effective intervention for pain relief and functional improvement. Using data from single military healthcare institutional records in India, we estimated the utilization rates of total knee replacement by age, gender and rank profile.
  
  
  METHODS
  All the data were retrieved manually from institutional records as the institutional databases are yet to be digitized. The information on the study subjects was retrospectively retrieved from the records of the Department of Orthopaedics from the year 1997 to 2012. Trends were estimated by using two 6-year periods separated by a decade, i.e. 1997-2002 and 2007-2012. We estimated age-, gender- and rank-specific rates of TKR utilization in these years.
  
  
  RESULTS
  From 1997 to 2002, 37 TKRs were performed as compared to 800 during 2007-2012, showing a more than 20 times increase. During 1997-2002, the mean age was 62.6 years (SD-9.224) compared to 65.8 years (SD-7.05). There was significant disparity in TKR utilization rates on the basis of rank with officers and their dependent, showing much higher utilization rates in both year groups which is possibly explained by the higher level of awareness about the procedure, higher education levels and higher acceptability of the procedure by the officers as compared to PBORs. The rate of TKR was marginally higher amongst women as compared to men.
  
  
  CONCLUSIONS
  The TKR utilization rates have increased tremendously over a decade. In view of this huge increase, future planning is essential to enable optimal material and human resource allocation as well as training to meet future challenges.
authors.affiliation: Orthopaedics, Military Hospital, Kirkee, Pune, 411020, Maharashtra, India. kumarnarinder1969@gmail.com.
authors.forename: Narinder
authors.initials: N
authors.lastname: Kumar
authors.affiliation: Griffith Health Institute, Griffith University, Parkland Drive, Gold Coast, QLD, 4222, Australia.
authors.forename: Bhawna
authors.initials: B
authors.lastname: Gupta
authors.affiliation: Orthopaedics, Military Hospital, Kirkee, Pune, 411020, Maharashtra, India.
authors.forename: Santosh Kumar
authors.initials: SK
authors.lastname: Singh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000706:statistics & numerical data / Q000639:trends*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
keywords: Osteoarthritis; Total knee replacement; Utilization trends