The utilisation of total knee replacement exceeds that predicted by population growth and obesity
Trieu, J.* (1), Dowsey, M. (1), Choong, P. (1,2)
1. Department of Surgery, University of Melbourne, St Vincent’s Hospital
2. Department of Orthopaedics, St Vincent’s Hospital
Total knee replacement surgery has been well established as a clinically and cost-effective intervention for symptomatic advanced osteoarthritis of the knee by relieving pain, improving function and providing a better quality of life. With increasing rates of overweight and obesity among growing populations that are living longer and expecting to maintain quality of life and functional independence, the demand for this surgery is expected to rise significantly. This surgery is expensive to perform and places great demand on limited healthcare resources. We sought to identify whether population growth and rise in prevalence of overweight and obesity can explain the significant rise in demand for Australia’s joint replacement surgery program. Although population size and obesity remain large driving factors, they do not account for 6.2% to 36.7% of the volume performed. The growth drivers of primary total knee arthroplasty are likely to be much more complex than previously considered. Possible factors include: a changing demography, higher prevalence of symptomatic knee osteoarthritis in obese patients, total knee arthroplasty in the arthroplasty-naïve patient versus patients with a previous total knee replacement, expanding indications and decision strata, and change in servicing levels. The locus of growth in utilisation rate and volume is in the 55-64- and 65-74-year-old age groups. There has been a translocation of surgery from patients >75 years to those <75 years, with insufficient evidence to inform the likely long-term outcomes and benefits in this younger patient cohort to balance the higher risk of revision surgery. There is an unmet clinical need to identify outcomes and the contributing factors that drive positive outcomes in knee replacement surgery for younger patients and this will require greater research efforts to inform an approach tailored for the patient’s characteristics and symptom profiles.
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For more information about this abstract, please contact:
Jason Trieu, Department of Surgery, The University of Melbourne
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