Medical Press, commenting on a study that counted the number of Americans who had received an artificial joint, reports that more than 7 million Americans are presently living with an artificial knee (4.7 million) or hip (2.5 million.) That amounts to 0.8% of the total population. But among adults age 50 and older the rate is 2.3% for hips and 4.6% for knees. For patients 80 years old and older the rate is nearly 10%.
7 Million Americans With Artificial Knees, Hips
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Daniel Berry, M.D., professor of orthopedics at Mayo Clinic and the senior author of the study, said, “This large number highlights how these operations have kept a substantial part of our population mobile despite severe arthritis, something that wouldn’t have been possible before these technologies were available. These prevalence estimates are within the same ballpark as coronary heart disease, and much higher than heart failure or stroke. To put these numbers in perspective, there are roughly one and a half times as many people living with a hip or knee replacement in the U.S. as people living with heart failure.”
Another finding of the study was that the incidence of total knee replacement (TKR) increased by 120% from 2000 to 2009, 188% for patients ages 45 to 64, and 89% for patients ages 65 to 84. The incidence of total hip replacement (THR) increased 73% from 2000 to 2009, 123% for patients ages 45 to 64 and 54% for ages 65 to 84.
Over the same time period, the number of TKR revisions increased by 133%, and the number of total hip replacement revisions went up by 27%.
Medical Press quoted William A. Jiranek, M.D., professor of orthopedics, Virginia Commonwealth University School of Medicine, as saying of the joint replacement patients, “They all need continuing medical attention and some need further surgical attention over the years of having a replacement. As there are no guidelines to define long-term management of these individuals…our prevalence estimates are vital to agencies charged with planning for the provision of health care services.”
An earlier study by a group of health economists found that, by modeling indirect savings of the individual returning to the work force after knee replacement surgery, the lifetime societal net benefit for patients undergoing that surgery averages between $10, 000 and $30, 000.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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