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Total knee arthroplasty in France: Male-driven rise in procedures in 2009–2019 and projections for 2050 - 19/08/23

Doi : 10.1016/j.otsr.2022.103463 
Mathieu Le Stum a, , Thomas Gicquel b, Guillaume Dardenne c, Myriam Le Goff-Pronost d, Eric Stindel c, e, Arnaud Clavé e, f
a Institut national de la santé et de la recherche médicale (Inserm), laboratoire de traitement de l’information médicale (LATIM), UMR1101, 22, avenue Camille-Desmoulins, 29200 Brest, France 
b Clinique mutualiste de la porte de l’Orient, 3, rue Robert-de-la-Croix, 56324 Lorient, France 
c Centre hospitalo-universitaire de Brest, CHRU de Brest, LATIM, UMR 1101, 2, avenue Foch, 29200 Brest, France 
d Institut Mines-Telecom, IMT Atlantique, LATIM - Inserm UMR 1101, M@rsouin, 655, avenue du Technopôle, 29280 Plouzane, France 
e Université de Bretagne Occidentale, UBO, LATIM, UMR 1101, 22, avenue Camille-Desmoulins, 29200 Brest, France 
f Service d’orthopédie, clinique Saint-George, 2, avenue de Rimiez, 06100 Nice, France 

Corresponding author.

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Abstract

Background

The number of Total Knee Arthroplasty (TKA) procedures has been rising steadily for several decades in Europe and the USA. The increase varies in pace across countries, with a gradual climb in northern and central Europe, a slowing in the USA, and an exponential surge in the UK. In France, a 32.2% rise in the number of TKA and unicompartmental knee arthroplasty procedures was documented between 2012 and 2018. However, no study has focussed specifically on changes in both TKA procedures and the features of TKA patients. The objective of this study was to use the French national healthcare database to evaluate (1) increases in TKA procedures according to sex and age, (2) whether TKA is being performed at increasingly younger ages, (3) whether the comorbidity profile at TKA is changing, and (4) whether the TKA incidence rate will stabilise in the future, with a projection for 2050.

Hypothesis

In France, the number of TKA procedures is rising in both males and females but the pace of the increases differs between sexes.

Material and method

This study used data collected in France in 2009–2019, separately for different age groups and for males and females, in the French national healthcare database (Système national des données de santé, SNDS) that collects information on all surgical procedures performed nationwide. Based on information about the TKA procedures, we determined (1) the TKA incidence rates with their time trends and (2) indirectly, the comorbidity profiles of the patients at TKA. Linear, Poisson, and logistic models were built to predict incidence rates in 2030, 2040, and 2050.

Results

Between 2009 and 2019, the TKA incidence rate showed a steeper increase in males than in females (from 71.2 to 122.9 [+73%] vs. 124.2 to 181.0 [+46%], respectively). Although this increase was replicated in all age groups, it was sharper in patients younger than 65 years, in both males and females (from 20.9 to 37.9 [+82%] and 33.6 to 51.3 [+53%], respectively). During the study period, the number and proportion of patients increased in the group with mild comorbidities (from 40 093 to 67 430 TKAs, i.e., from 53.1% to 65.7% of all TKAs) but not in the other comorbidity groups. All projection models were validated. Nonetheless, the most likely scenario, provided by the logistic model, is a 33% rise by 2050 in both males and females (i.e., to 151 575 TKA procedures) with a plateau starting around 2030.

Conclusion

Although the increase in TKA procedures is more marked in males than in females, the trends are similar in both sexes, with a sharper rise in the group younger than 65 years and a shift toward patients with milder comorbidities. In the longer term, incidence rate trends follow logistic dynamics, with a plateau starting around 2030. To meet the increasing demand, a corresponding development in relevant healthcare resources must be planned.

Level of evidence

IV, descriptive epidemiological study.

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Keywords : Total knee arthroplasty, Knee, Projection, Epidemiology, Comorbidity


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Vol 109 - N° 5

Article 103463- septembre 2023 Retour au numéro
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