While the need for a joint replacement in a sense represents a failure of measures to prevent the occurrence or progression of joint problems, for those with the severe pain or poor function of end-stage joint problems, it can represent a life-altering “cure.” Joint replacement procedures for hips and knees are most common, but replacements have been expanding to other joint sites over the past few years. Joint replacements represent one of the fastest growing procedures in the United States.
Data are provided for both of the two national hospital discharge databases for comparison purposes. Although they vary slightly in the number of cases, overall they provide relatively consistent estimates of inpatient joint replacement procedures.
In 2010 and 2011, there were an estimated 1.3 to 1.4 million inpatient joint replacement procedures. Joint replacement procedures comprised about 3.5% of all inpatient procedures for those years. More joint replacements are performed on women than men, and 93% of the procedures are performed on knees or hips. (Reference Table 4.9 PDF [1] CSV [2])
In 2010 and 2011, an estimated 706,000 to 757,000 knee replacement procedure were performed on patients in the United States, comprising 56% of all joint replacement procedures. Three in five knee replacements occurred in females. Total knee replacements far exceeded revision knee replacements, which occur when the original replacement fails or becomes infected. (Reference Table 4.9 PDF [1] CSV [2])
Estimated trends in knee replacement procedures from 1992 to 2010 or 2011 show steady increases in both total and revision knee replacements. Over the 18 years, knee replacement procedures approximately tripled, with the ratio of revisions to total remaining constant at 8% to 10%. (Reference Table 4.10 PDF [3] CSV [4]).
The principal diagnosis associated with total knee replacement is osteoarthritis, accounting for 95% or more of all replacements. (Reference Table 4.11 PDF [5] CSV [6]).
The mean age for both total knee and revision knee replacements was 68 years over an 18-year period. The mean age for both procedures shows a slow decline over this time period. (Reference Table 4.12 PDF [7] CSV [8])
The mean length of stay for both total and revision knee replacements has shown a remarkable decline of about 50% from a mean of nearly 9 days in 1992 to a mean of 3.5 days in 2010. (Reference Table 4.13 PDF [9] CSV [10]).
In spite of shorter hospital stays, the mean hospital charges from 1998 through 2011 showed steady increases for both knee replacements, with revision knee replacement being more expensive than total knee replacement. Total hospitalization charges for both knee replacements have more than quadrupled (in constant 2011 dollars) from $8.1 billion in 1998 to $38.5 billion in 2011. (Reference Table 4.14 PDF [11] CSV [12])
Most adults with knee replacements are routinely discharged home, with 20% to 30% discharged to long-term care. Among persons age 65 years and older, a slightly higher proportion are discharged to long-term care. (Reference Table 4.15 PDF [13] CSV [14]).
In 2010 and 2011, there were an estimated 465,000 to 512,000 hip replacement procedures, comprising 37% of all joint replacement procedures. A majority, about 63%, occurred in females. Total hip replacements occur nearly three times as frequently as partial hip replacements, and both are far more common that revision hip replacement. (Reference Table 4.9 PDF [1] CSV [2])
Estimated trends in hip replacement procedures from 1992 to 2010 or 2011 show a steady increase in all types of replacements, with total hip replacements more than doubling by 2010/2011. Growth is slowest in partial hip replacements. The ratio of revision hip to total hip replacements hovers around 20% for most years. The years 2006/2007 showed anomaly data for revision hip replacements in both data sets. (Reference Table 4.10 PDF [3] CSV [4])
The principal diagnoses associated with hip replacements varied, with osteoarthritis associated with more than 80% of total hip replacements and fractures or congenital deformities being associated with more than 85% of partial hip replacements. There is some variation between diagnoses for the two databases. (Reference Table 4.11 PDF [5] CSV [6])
The 18-year mean age was about 66 years for total hip replacements and 77 for partial hip replacements, reflecting the different underlying diagnoses. Mean ages for both procedures show a slight decline over the time period, reflecting the younger age at which joint replacements are now considered. (Reference Table 4.12 PDF [7] CSV [8])
The mean length of stay for all hip replacements has shown a remarkable decline of at least 50% from 1992 through 2010. (Reference Table 4.13 PDF [9] CSV [10])
In spite of shorter hospital stays, mean hospital charges from 1998 through 2011 steadily increase for all hip replacements. Revision hip replacements are the most expensive, while total hip replacements are the least expensive. Total hospitalization charges for all hip replacements have tripled (in constant 2011 dollars) from $8.9 billion in 1998 to $27.8 billion in 2011, led by charges for total hip replacements. (Reference Table 4.14 PDF [11] CSV [12])
Most adults with total hip and revision hip replacements are routinely discharged home, but 20% to 30% are discharged to long-term care. Slightly higher rates of persons age 65 years and older go to long-term care. Among patients who undergo a partial hip replacement, nearly half (45%) go to long-term care, with three out of five who are 65 years and older with a partial hip replacement doing so. (Reference Table 4.15 PDF [13] CSV [14])
In 2010 and 2011, an estimated 67,000 to 76,000 shoulder replacement procedures were performed, comprising 5% to 6% of all joint replacement procedures. At the same time, an estimated 19,000 to 25,000 other joint replacement procedures were performed. This small group, which includes fingers, toes, wrist, ankle, and spine replacements, comprise less than 2% of all joint replacement procedures. As with hip and knee replacements, a majority of other joint replacement procedures occurred in females. (Reference Table 4.9 PDF [1] CSV [2])
Links:
[1] https://www.boneandjointburden.org/docs/T4.9.pdf
[2] https://www.boneandjointburden.org/docs/T4.9.csv
[3] https://www.boneandjointburden.org/docs/T4.10.pdf
[4] https://www.boneandjointburden.org/docs/T4.10.csv
[5] https://www.boneandjointburden.org/docs/T4.11.pdf
[6] https://www.boneandjointburden.org/docs/T4.11.csv
[7] https://www.boneandjointburden.org/docs/T4.12.pdf
[8] https://www.boneandjointburden.org/docs/T4.12.csv
[9] https://www.boneandjointburden.org/docs/T4.13.pdf
[10] https://www.boneandjointburden.org/docs/T4.13.csv
[11] https://www.boneandjointburden.org/docs/T4.14.pdf
[12] https://www.boneandjointburden.org/docs/T4.14.csv
[13] https://www.boneandjointburden.org/docs/T4.15.pdf
[14] https://www.boneandjointburden.org/docs/T4.15.csv