title: Predicting the Burden of Revision Knee Arthroplasty: Simulation of a 20-Year Horizon.
abstract: To estimate future utilization scenarios for knee arthroplasty (KA) revision in the Spanish National Health System in the short- and long-term and their impact on primary KA utilization.
  
  
  
  A discrete-event simulation model was built to represent KA utilization for 20 years (2012-2031) in the Spanish National Health System. Data on KA utilization from 1997 to 2011 were obtained from the minimum data set. Three scenarios of future utilization of primary KA (1, fixed number since 2011; 2, fixed age- and sex-adjusted rates since 2011; and 3, projection using a linear regression model) were combined with two prosthesis survival functions (W [worse survival], from a study including primary KA from 1995 to 2000; and B [better survival], from the Catalan Registry of Arthroplasty, including primary KA from 2005 to 2013). The simulation results were analyzed in the short-term (2015) and the long-term (2030).
  
  
  
  Variations in the number of revisions depended on both the primary utilization rate and the survival function applied, ranging from increases of 8.3% to 31.6% in the short- term and from 38.3% to 176.9% in the long-term, corresponding to scenarios 1-B and 3-W, respectively. The prediction of increases in overall surgeries ranged from 0.1% to 22.3% in the short-term and from 3.7% to 98.2% in the long-term.
  
  
  
  Projections of the burden of KA provide a quantitative basis for future policy decisions on the concentration of high-complexity procedures, the number of orthopedic surgeons required to perform these procedures, and the resources needed.
authors: Epidemiology and Evaluation Department, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
authors: Richard E
authors: RE
authors: Guerrero-Ludueña
authors: Epidemiology and Evaluation Department, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Health Services Research on Chronic Patients Network (Red de Investigación en Servicios de Salud en Enfermedades Crónicas [REDISSEC]), Barcelona, Spain. Electronic address: mcomas@parcdesalutmar.cat.
authors: Mercè
authors: M
authors: Comas
authors: Health Services Research on Chronic Patients Network (Red de Investigación en Servicios de Salud en Enfermedades Crónicas [REDISSEC]), Barcelona, Spain; Agency for Health Quality and Assessment of Catalonia (Agència de Qualitat i Avaluació Sanitàries de Catalunya [AQuAS]), Barcelona, Spain.
authors: Mireia
authors: M
authors: Espallargues
authors: Traumatology and Orthopaedic Surgery Department, Hospital de Mataró, Mataró, Spain.
authors: Moisès
authors: M
authors: Coll
authors: Traumatology and Orthopaedic Surgery Department, Hospital de Sant Rafael, Barcelona, Spain.
authors: Miquel
authors: M
authors: Pons
authors: Traumatology and Orthopaedic Surgery Department, Hospital Mútua de Terrassa, Terrassa, Spain.
authors: Santiago
authors: S
authors: Sabatés
authors: Agency for Health Quality and Assessment of Catalonia (Agència de Qualitat i Avaluació Sanitàries de Catalunya [AQuAS]), Barcelona, Spain.
authors: Alejandro
authors: A
authors: Allepuz
authors: Epidemiology and Evaluation Department, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Health Services Research on Chronic Patients Network (Red de Investigación en Servicios de Salud en Enfermedades Crónicas [REDISSEC]), Barcelona, Spain.
authors: Xavier
authors: X
authors: Castells
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000706:statistics & numerical data*; D003198:Computer Simulation; D005260:Female; D005544:Forecasting; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D020370:Osteoarthritis, Knee / Q000601:surgery; D011475:Prosthesis Failure; D012042:Registries; D012086:Reoperation / Q000639:trends*; D013030:Spain
keywords: burden of illness; health care utilization; osteoarthritis; simulation models