Total joint arthroplasty poised to see incredible growth in the coming decades
Douglas W. Jackson, MD, asks Steven M. Kurtz, PhD, and Kevin L. Ong, PhD, four questions about the projected rise in demand for joint arthroplasty.
Projections on future joint arthroplasty demands have not been accurate in the past because many factors may be unseen at the time a prediction is made. For example, the advent and impact of arthroscopic surgery led to a significant increase in the number of surgeries performed by orthopedic surgeons over what that was anticipated.
This month’s 4-Questions takes on the anticipated increase in joint arthroplasty procedures over the next 25 years. To provide us with data and special insight, I turned to Steven M. Kurtz, PhD, and Kevin L. Ong, PhD, to answer specific questions related to this projected increase in demand for orthopedic surgeons doing joint arthroplasty.
Douglas W. Jackson, MD: What is the projected demand for primary and revision total hip and knee replacement in the United States by 2030?
Steven M. Kurtz, PhD, and Kevin L. Ong, PhD: By 2030, the demand for primary total hip arthroplasty (THA) is estimated to grow annually from 209,000 to 572,000 and the demand for primary total knee arthroplasty (TKA) is projected to grow from 450,000 to 3.48 million procedures.
Total hip revisions are projected to grow from 40,800 in 2005 to 96,700 in 2030.
Total knee revisions are projected to grow from 38,300 in 2005 to 268,200 in 2030.
Jackson: What percentages of growth does this represent from the current level?
Kurtz and Ong: The projected demand change for primary THA is an increase of 174% and the demand for primary TKA is a 673% increase by the year 2030. The rise in total hip revision procedures will be a 137% increase by that time.
If the trends that have been observed from 1990-2003 are to continue, TKA revisions are projected to grow by 601%. The demand for hip revision procedures is projected to double by the year 2026, while the demand for knee revisions is expected to double by 2015.
Jackson: What factors could significantly change your projections?
Kurtz and Ong: Our projections considered temporal changes in joint replacement rates and population trends. Advanced implant designs could potentially reduce the incidence of revision surgery.
The implementation of a nationwide arthroplasty registry in the United States, with constructive feedback to surgeons and hospitals, could potentially reduce the rate of revisions.
In addition, it is unclear if future orthopedic treatment technologies or newer pharmaceutical non-surgical interventions will lead to fewer primary total joint replacement procedures by 2030. Economic factors, such as Medicare reimbursements, could also affect the adoption of these procedures.
Jackson: How will our health care systems meet this projected increased demand?
Kurtz and Ong: The growing demand may be met through improved operative efficiency through the use of smart tools or hospital standardization programs to streamline the procedure while maintaining quality of care, which will allow increased surgical capacity.
Training of additional surgeons or increasing the volume of lower volume surgeons/hospitals may be needed to help cope with the expected demand.
The increased demand could also be met with advanced devices to extend the longevity of the implants, hence minimizing the need for revision surgery. Finally, substantial additional economic resources will be needed to accommodate the projected demand for primary and revision surgery.
For more information:
- Steven M. Kurtz, PhD, can be reached 3401 Market St., Suite 300, Philadelphia, PA 19104; 215-594-8851; e-mail: firstname.lastname@example.org.
- Kevin L. Ong, PhD, can be reached at 3401 Market St., Suite 300, Philadelphia, PA 19104; 215-594-8874; e-mail: email@example.com.
- Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg AM. 2007;89(4):780-785.