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Trends in total knee and hip arthroplasty recipients: a retrospective cohort study
  1. Jiabin Liu1,2,
  2. Lauren Wilson1,
  3. Jashvant Poeran3,
  4. Megan Fiasconaro1,
  5. David H Kim1,2,
  6. Elaine Yang1,2 and
  7. Stavros Memtsoudis1,2
  1. 1Departments of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA
  2. 2Department of Anesthesiology, Weill Cornell Medicine, New York, New York, USA
  3. 3Departments of Orthopaedics/Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  1. Correspondence to Dr Jiabin Liu, Anesthesiology, Hospital for Special Surgery, New York, NY 10021, USA; liuji{at}


Background Arthroplasty is one of the most commonly performed procedures in the USA with projections of continuous growth. As this field undergoes continuous changes, the goal of this study was to provide an analysis of patient-related and healthcare system-related trends. This is important as it allows practitioners, administrators and policy makers to allocate needed resources appropriately.

Methods The study included total knee arthroplasty (TKA) and total hip arthroplasty (THA) procedures from 2006 to 2016. Demographic information, comorbidities and complications were extracted and analyzed from the Premier Healthcare database.

Results The surgical volume increased annually over the observation period by an average of 5.54% for TKA and 7.02% for THA, respectively. The average age of the patient population and the types of anesthesia used remained relatively consistent over time. Comorbidity burden increased, especially for obesity (16.52% in 2006 and 29.77% in 2016 for TKA, 11.15% in 2006 and 20.92% in 2016 for THA), obstructive sleep apnea (OSA) (6.82% in 2006 and 17.03% in 2016 for TKA, 4.69% in 2006 and 12.72% in 2016 for THA) and renal insufficiency (2.81% in 2006 and 7.01% in 2016 for TKA, 2.78% in 2006 and 6.43% in 2016 for THA). Minor trends of increases were also observed in the prevalence of liver disease, depression and hypothyroidism. All postoperative complications were trending lower except for acute renal failure, where an increase was noted (4.39% in 2006 and 8.10% in 2016 for TKA, 4.99% in 2006 and 8.42% in 2016 for THA).

Discussion Significant trends in the care of patients who undergo TKA and THA were identified. Individuals undergoing these procedures presented with a higher prevalence of comorbidities. Despite these trajectories, complications declined over time. These data can be used to inform future research and to allocate resources to address changes in populations cared for and complications encountered.

  • total knee arthroplasty
  • total hip arthroplasty
  • trend
  • comorbidity burden
  • postoperative complications

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  • Contributors Study planning, conception and design: JL, LW, JP and SM. Acquisition of data or analysis: LW, MF and SM. Interpretation of data and writing of the manuscript: JL, LW, SP, MF, DHK, EY and SM.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The institutional review board (IRB #2012–050) approved the study and waived the requirement for written informed consent.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available.