Demographic and Socioeconomic Trends of Patients Undergoing Total Knee Arthroplasty from 2013 to 2022 – An Analysis from an Urban Orthopaedic Hospital

Abstract

IntroductionAs worldwide utilization of total knee arthroplasty (TKA) broadens, demographic trends can help make projections to inform access to care. This study aimed to assess the temporal trends in the socioeconomic and medical demographics of patients undergoing TKA. MethodsA retrospective review of 15,848 patients who underwent primary, elective TKA at an urban, New York City-based, academic medical center between January 2013 and September 2022 was performed. Trends in patients’ age, body mass index (BMI), socioeconomic status (SES) (based on median income by patients’ ZIP code), race, and Charlson comorbidity index (CCI) were evaluated using the Mann-Kendall test. ResultsIn the last decade, mean patient age (65 to 68 years, P < 0.001) and CCI (1.4 to 2.3, P < 0.001) increased significantly. The proportion of patients who had a BMI ≥ 30 and < 40 increased (43.8 to 51.2%, P = 0.002), while the proportion of patients who had a BMI ≥ 40 (13.7 to 12.1%, P = 0.015) and BMI < 30 (42.5 to 36.8%, P = 0.020) decreased. The distribution of patients’ race and SES did not change from 2013 to 2022; Black (18.1 to 16.8%, P = 0.211) and low SES (12.9 to 11.3%, P = 0.283) patients consistently represented a minority of TKA patients. ConclusionsOver the last decade, the average age and comorbidity burden of TKA patients at our institution have increased. This portends the need for higher levels of preoperative optimization and postoperative management for TKA patients. A decreased prevalence of BMI ≥ 40 could reflect optimization efforts. However, the consistently low prevalence of Black and low-SES patients suggests that recent payment models did not improve access to care for these populations.