Increases in the rates of primary and revision knee replacement are reducing: a 15-year registry study across 3 continents

Peter L Lewis; Stephen E Graves; Otto Robertsson; Martin Sundberg; Elizabeth W Paxton; Heather A Prentice; Annette W- Dahl

doi:10.1080/17453674.2020.1749380

Authors

Peter L Lewis Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, Australia; Lund University, Faculty of Medicine, Clinical Sciences Lund, Department of Orthopedics, Lund, Sweden
Stephen E Graves Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, Australia
Otto Robertsson Swedish Knee Arthroplasty Register, Lund, Sweden; Lund University, Faculty of Medicine, Clinical Sciences Lund, Department of Orthopedics, Lund, Sweden
Martin Sundberg Swedish Knee Arthroplasty Register, Lund, Sweden; Lund University, Faculty of Medicine, Clinical Sciences Lund, Department of Orthopedics, Lund, Sweden
Elizabeth W Paxton Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, CA, USA
Heather A Prentice Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, CA, USA
Annette W- Dahl Swedish Knee Arthroplasty Register, Lund, Sweden; Lund University, Faculty of Medicine, Clinical Sciences Lund, Department of Orthopedics, Lund, Sweden

DOI:

https://doi.org/10.1080/17453674.2020.1749380

Abstract

Background and purpose — Rates of knee replacement (KR) are increasing worldwide. Based on population and practice changes, there are forecasts of a further exponential increase in primary knee replacement through to 2030, and a corresponding increase in revision knee replacement. We used registry data to document changes in KR over the past 15 years, comparing practice changes across Sweden, Australia, and the United States. This may improve accuracy of future predictions.

Patients and methods — Aggregated data from the Swedish Knee Arthroplasty Register (SKAR), the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), and the Kaiser Permanente Joint Replacement Registry (KPJRR) were used to compare surgical volume of primary and revision KR from 2003 to 2017. Incidence was calculated using population census statistics from Statistics Sweden and the Australian Bureau of Statistics, as well as the yearly active membership numbers from Kaiser Permanente. Further analysis of KR by age < 65 and ≥ 65 years was carried out.

Results — All registries recorded an increase in primary and revision KR, with a greater increase seen in the KPJRR. The rate of increase slowed during the study period. In Sweden and Australia, there was a smaller increase in revision surgery compared with primary procedures. There was consistency in the mean age at surgery, with a steady small decrease in the proportion of women having primary KR. The incidence of KR in the younger age group remained low in all 3 registries, but the proportional increases were greater than those seen in the ≥ 65 years of age group.

Interpretation — There has been a generalized deceleration in the rate of increase of primary and revision KR. While there are regional differences in KR incidence, and rates of change, the rate of increase does not seem to be as great as previously predicted.