0
Scientific Articles   |    
Epidemiology of Total Knee Replacement in the United States Medicare Population
Nizar N. Mahomed, MD, ScD1; Jane Barrett, MSc2; Jeffrey N. Katz, MD, MS3; John A. Baron, MD, MSc2; John Wright, MD3; Elena Losina, PhD4
1 Musculoskeletal Health and Arthritis Program, Toronto Western Hospital, University Health Network, 399 Bathurst Street, University of Toronto, Toronto, Ontario M5T 2S8, Canada
2 Departments of Medicine (J.A.B.) and Community Medicine (J.A.B., J.B.) Dartmouth Medical School, 46 Centerra Parkway #300, Lebanon, NH 03766
3 Division of Rheumatology, Immunology and Allergy (J.N.K.) and Department of Orthopaedic Surgery (J.W.), Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115. E-mail address for J.N. Katz: jnkatz@partners.org
4 Department of Biostatistics, Boston University School of Public Health, 715 Albany Street, TE421, Boston, MA 02118
View Disclosures and Other Information
Note: The authors thank Robert A. Lew, PhD, for contributing to the design of the study.
Investigation performed at the Section of Clinical Sciences and the Division of Rheumatology, Immunology and Allergy, the Robert Brigham Arthritis and Musculoskeletal Clinical Research Center, Boston, Massachusetts; the Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; the Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts; the Departments of Medicine and Community Medicine, Dartmouth Medical School, Lebanon, New Hampshire; and the Musculoskeletal Health and Arthritis Program, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2005 Jun 01;87(6):1222-1228. doi: 10.2106/JBJS.D.02546
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case

Abstract

Background: There are limited population-based data on the utilization and outcomes of total knee replacement. The aim of the present study was to describe the rates of primary and revision total knee replacement and selected outcomes in persons older than sixty-five years of age in the United States.

Methods: Using Medicare claims, we computed annual incidence rates of unilateral elective primary and revision total knee replacement among United States Medicare beneficiaries in the year 2000. Poisson regression was used to assess the relationships between demographic characteristics and the incidence rates of primary and revision knee replacement. Proportional hazards models were used to examine the relationships between the ninety-day rates of complications and demographic and clinical factors.

Results: The rate of primary knee replacement was lower in blacks than in whites and in those qualifying for Medicaid supplementation than in those with higher incomes. The complications observed during the ninety days following primary knee replacement included mortality (0.7%), readmission (0.9%), pulmonary embolus (0.8%), wound infection (0.4%), pneumonia (1.4%), and myocardial infarction (0.8%). The complications observed during the ninety days following revision knee replacement were mortality (1.1%), readmission (4.7%), pulmonary embolus (0.5%), wound infection (1.8%), pneumonia (1.4%), and myocardial infarction (1.0%). Blacks had higher rates of mortality, readmission, and wound infection after primary knee replacement than whites did. Patients who qualified for Medicaid supplementation had higher complication rates, particularly after primary knee replacement.

Conclusions: Overall, the rates of postoperative complications during the ninety days following total knee replacement are low. In the United States, blacks and individuals with low income undergo total knee replacement less frequently and generally have higher rates of adverse outcomes following primary knee replacement.

Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.

Figures in this Article
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

     
    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org

    References

    Accreditation Statement
    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.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe





    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Topic Collections
    Related Audio and Videos
    PubMed Articles
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    04/16/2014
    Ohio - OhioHealth Research and Innovation Institute (OHRI)
    04/23/2014
    Massachusetts - UMass Memorial Medical Center
    01/08/2014
    Pennsylvania - Penn State Milton S. Hershey Medical Center