Scientific Articles   |    
Estimating the Burden of Total Knee Replacement in the United States
Alexander M. Weinstein, BA1; Benjamin N. Rome, BA1; William M. Reichmann, MA1; Jamie E. Collins, MA1; Sara A. Burbine, BA1; Thomas S. Thornhill, MD1; John Wright, MD1; Jeffrey N. Katz, MD, MSc1; Elena Losina, PhD1
1 Orthopaedic and Arthritis Center for Outcomes Research (A.M.W., B.N.R., W.M.R., J.E.C., S.A.B., J.N.K., and E.L.) and Department of Orthopedic Surgery (T.S.T. and J.W.), Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115. E-mail address for E. Losina: elosina@partners.org
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Investigation performed at the Orthopaedic and Arthritis Center for Outcomes Research and the Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts

Alexander M. Weinstein, BA, and Benjamin N. Rome, BA, contributed equally to the preparation of this article.

This article was chosen to appear electronically on January 23, 2013, in advance of publication in a regularly scheduled issue

Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Mar 06;95(5):385-392. doi: 10.2106/JBJS.L.00206
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In the last decade, the number of total knee replacements performed annually in the United States has doubled, with disproportionate increases among younger adults. While total knee replacement is a highly effective treatment for end-stage knee osteoarthritis, total knee replacement recipients can experience persistent pain and severe complications. We are aware of no current estimates of the prevalence of total knee replacement among adults in the U.S.


We used the Osteoarthritis Policy Model, a validated computer simulation model of knee osteoarthritis, and data on annual total knee replacement utilization to estimate the prevalence of primary and revision total knee replacement among adults fifty years of age or older in the U.S. We combined these prevalence estimates with U.S. Census data to estimate the number of adults in the U.S. currently living with total knee replacement. The annual incidence of total knee replacement was derived from two longitudinal knee osteoarthritis cohorts and ranged from 1.6% to 11.9% in males and from 2.0% to 10.9% in females.


We estimated that 4.0 million (95% confidence interval [CI]: 3.6 million to 4.4 million) adults in the U.S. currently live with a total knee replacement, representing 4.2% (95% CI: 3.7% to 4.6%) of the population fifty years of age or older. The prevalence was higher among females (4.8%) than among males (3.4%) and increased with age. The lifetime risk of primary total knee replacement from the age of twenty-five years was 7.0% (95% CI: 6.1% to 7.8%) for males and 9.5% (95% CI: 8.5% to 10.5%) for females. Over half of adults in the U.S. diagnosed with knee osteoarthritis will undergo a total knee replacement.


Among older adults in the U.S., total knee replacement is considerably more prevalent than rheumatoid arthritis and nearly as prevalent as congestive heart failure. Nearly 1.5 million of those with a primary total knee replacement are fifty to sixty-nine years old, indicating that a large population is at risk for costly revision surgery as well as possible long-term complications of total knee replacement.

Clinical Relevance: 

These prevalence estimates will be useful in planning health services specific to the population living with total knee replacement.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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