Recent downturns in the economy have had little or no effect on the growth in hip and knee arthroplasty in the United States—which is good news for orthopedic surgeons. Steven M. Kurtz, Ph.D. and his colleagues from Exponent, Inc., in Philadelphia found that the trend for joint replacement surgery in the U.S. population has been “insensitive to economic turndowns.”
Orthopedics Indifferent to Economic Trends

Their report states, “The total number of procedures increased by 6.0% from 2009 to 2010 for primary total hip arthroplasty, 6.1% for primary total knee arthroplasty, 10.8% for revision total hip arthroplasty, and 13.5% for revision total knee arthroplasty.”
“The available data do not support the hypothesis that the anticipated long-term national demand for joint replacements has been fundamentally altered by the current recessionary economic environment, ” said Dr. Kurtz, who was also lead author of the previous 2007 study. “They suggest instead that the long-term trends for the demand in total joint arthroplasty appear to be recession-proof.”
The authors published their study in the April issue of The Journal of Bone and Joint Surgery. They used government projections of National Health Expenditure from 2011 to 2021 as well as a regression model to estimate future arthroplasty rates in the U.S.

Discussion
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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