title: Substantial rise in the lifetime risk of primary total knee replacement surgery for osteoarthritis from 2003 to 2013: an international, population-level analysis.
abstract: To estimate and compare the lifetime risk of total knee replacement surgery (TKR) for osteoarthritis (OA) between countries, and over time.
  
  
  
  Data on primary TKR procedures performed for OA in 2003 and 2013 were extracted from national arthroplasty registries in Australia, Denmark, Finland, Norway and Sweden. Life tables and population data were also obtained for each country. Lifetime risk of TKR was calculated for 2003 and 2013 using registry, life table and population data.
  
  
  
  Marked international variation in lifetime risk of TKR was evident, with females consistently demonstrating the greatest risk. In 2013, Finland had the highest lifetime risk for females (22.8%, 95%CI 22.5-23.1%) and Australia had the highest risk for males (15.4%, 95%CI 15.1-15.6%). Norway had the lowest lifetime risk for females (9.7%, 95%CI 9.5-9.9%) and males (5.8%, 95%CI 5.6-5.9%) in 2013. All countries showed a significant rise in lifetime risk of TKR for both sexes over the 10-year study period, with the largest increases observed in Australia (females: from 13.6% to 21.1%; males: from 9.8% to 15.4%).
  
  
  
  Using population-based data, this study identified significant increases in the lifetime risk of TKR in all five countries from 2003 to 2013. Lifetime risk of TKR was as high as 1 in 5 women in Finland, and 1 in 7 males in Australia. These risk estimates quantify the healthcare resource burden of knee OA at the population level, providing an important resource for public health policy development and healthcare planning.
authors.affiliation: Monash University, Melbourne, Australia; The University of Melbourne, Melbourne, Australia. Electronic address: ilana.ackerman@monash.edu.
authors.forename: I N
authors.initials: IN
authors.lastname: Ackerman
authors.affiliation: The University of Melbourne, Melbourne, Australia. Electronic address: megan.bohensky@unimelb.edu.au.
authors.forename: M A
authors.initials: MA
authors.lastname: Bohensky
authors.affiliation: The University of Melbourne, Melbourne, Australia; Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, Australia. Electronic address: Richard.Desteiger@epworth.org.au.
authors.forename: R
authors.initials: R
authors.lastname: de Steiger
authors.affiliation: Monash University, Melbourne, Australia; The University of Melbourne, Melbourne, Australia. Electronic address: caroline.brand@monash.edu.
authors.forename: C A
authors.initials: CA
authors.lastname: Brand
authors.affiliation: Coxa Hospital for Joint Replacement, Tampere, Finland. Electronic address: antti.eskelinen@fimnet.fi.
authors.forename: A
authors.initials: A
authors.lastname: Eskelinen
authors.affiliation: The Norwegian Arthroplasty Register, Bergen, Norway. Electronic address: anne.marie.fenstad@helse-bergen.no.
authors.forename: A M
authors.initials: AM
authors.lastname: Fenstad
authors.affiliation: The Norwegian Arthroplasty Register, Bergen, Norway; University of Bergen, Bergen, Norway. Electronic address: ove.nord.furnes@helse-bergen.no.
authors.forename: O
authors.initials: O
authors.lastname: Furnes
authors.affiliation: University of Gothenburg, Gothenburg, Sweden; Swedish Hip Arthroplasty Register, Gothenburg, Sweden. Electronic address: Goran.Garellick@registercentrum.se.
authors.forename: G
authors.initials: G
authors.lastname: Garellick
authors.affiliation: Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, Australia. Electronic address: segraves@aoanjrr.org.au.
authors.forename: S E
authors.initials: SE
authors.lastname: Graves
authors.affiliation: The Finnish Arthroplasty Register, Helsinki, Finland. Electronic address: jaason.haapakoski@thl.fi.
authors.forename: J
authors.initials: J
authors.lastname: Haapakoski
authors.affiliation: The Norwegian Arthroplasty Register, Bergen, Norway; University of Bergen, Bergen, Norway. Electronic address: leif.ivar.havelin@helse-bergen.no.
authors.forename: L I
authors.initials: LI
authors.lastname: Havelin
authors.affiliation: The Finnish Arthroplasty Register, Helsinki, Finland; Turku University Hospital, Turku, Finland. Electronic address: Keijo.Makela@tyks.fi.
authors.forename: K
authors.initials: K
authors.lastname: Mäkelä
authors.affiliation: Aarhus University Hospital, Aarhus, Denmark; Danish Knee Arthroplasty Register, Aarhus, Denmark. Electronic address: fm@clin.au.dk.
authors.forename: F
authors.initials: F
authors.lastname: Mehnert
authors.affiliation: Aarhus University Hospital, Aarhus, Denmark; Danish Knee Arthroplasty Register, Aarhus, Denmark. Electronic address: abp@clin.au.dk.
authors.forename: A B
authors.initials: AB
authors.lastname: Pedersen
authors.affiliation: The Swedish Knee Arthroplasty Register, Lund, Sweden; Lund University, Lund, Sweden. Electronic address: otto.robertsson@med.lu.se.
authors.forename: O
authors.initials: O
authors.lastname: Robertsson
mesh_terms: D000328:Adult; D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000639:trends*; D001315:Australia; D003718:Denmark; D005260:Female; D005387:Finland; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway; D020370:Osteoarthritis, Knee / Q000601:surgery*; D012189:Retrospective Studies; D012306:Risk; D012737:Sex Factors; D013548:Sweden
keywords: Epidemiology; Health service utilisation; Knee arthroplasty; Knee replacement; Osteoarthritis