A Prospective Study of 80,000 Total Joint and 5000 Anterior Cruciate Ligament Reconstruction Procedures in a Community-Based Registry in the United States

Abstract

Health-care costs in the United States have increased substantially over time. From 1980 to 2007, the percentage of gross national product spent on health care has increased from 8.8% to 16%1. Total joint replacement is one of the most costly diagnosis-related groups, with >600,000 procedures performed each year in the United States2,3. The demand for total joint replacement is expected to increase in the United States as a result of advances in medical technology, an increased prevalence of obesity, and an increasing aging population2,4. By 2030, annual volumes are projected to increase by 673% for primary total knee arthroplasty and by 174% for primary total hip arthroplasty4. The demand for revision total knee and total hip arthroplasty is also projected to increase by 601% and 137%, respectively. Total knee and total hip arthroplasty costs are also expected to increase dramatically, with annual hospital charges estimated to reach $40.8 billion for primary total knee arthroplasty and $17.4 billion for primary total knee arthroplasty by 20155. Similar increases in cost are projected for revision total knee and total hip arthroplasty. Wilson et al. estimated that by 2030, total knee arthroplasty and total hip arthroplasty will cost Medicare over $50 billion6. In addition to increases in demand and cost, recent concerns about metal-on-metal bearing surfaces7 and recent implant recalls and advisories have emphasized the need to monitor total joint outcomes nationwide. The identification of procedures and implants associated with higher revision rates could prevent revision procedures, improving care and addressing the increased cost and demand associated with this procedure. Joint registries provide one potential solution for reducing total joint replacement implant variation and revision rates. The Swedish Hip Register8-11 has demonstrated the effectiveness …