Department of Surgery, University of Toronto, Toronto, Canada.
Best Pract Res Clin Rheumatol. 2012 Oct;26(5):637-47. doi: 10.1016/j.berh.2012.07.014.
The rates of total joint arthroplasty (TJA) of the hip and knee have increased in North America over the last decade. While initially designed for elderly patients (>70 years of age), several reports suggest that an increasing number of younger patients are undergoing joint replacements. This suggests that more people are meeting the indication for TJA earlier in their lives. Alternatively, it might indicate a broadening of the indications for TJA.
We used the administrative databases available at the Healthcare Cost and Utilization Project (HCUP) and the Institute for Clinical Evaluative Sciences (ICES) to determine the rates of TJA of the hip and knee in the United States, and Ontario, Canada, respectively. We determined the crude rates of THA and TKA in both areas for four calendar years (2001, 2003, 2005 and 2007). We also calculated the age- and sex-standardised rates of THA and TKA in both areas for each time period. We compared the age distribution of TJA recipients between the US and Ontario, and within each area over time.
The crude and standardised rates of THA and TKA increased over time in both the US and Ontario. The crude rates of THA were higher in the US in 2001 and 2003, but were not significantly different from the rate in Ontario in 2005 and 2007. The crude rates of TKA were consistently higher in the US for all time periods. In addition, the US consistently had more THA and TKA recipients in 'younger' age categories (<60 years of age). While the age- and sex-standardised rates of TKA were greater in the US in all time periods, the relative increase in rates from 2001 to 2007 was greater in Ontario (US - 59%, Ontario - 73%). For both the US and Ontario, there was a significant shift in the demographic of THA and TKA recipients to younger patients (p < 0.0001).
The utilisation of primary hip and knee arthroplasty has increased substantially in both the US and Ontario in the period from 2001 to 2007. This increase has been predominantly in knee replacements. The demographics of joint replacement recipients has become younger, with substantial increases in the prevalence of patients <60 years old amongst TJA recipients, and significant increases in the incidence of TJA in these age groups in the general population, in both the US and Ontario.
在过去十年中，北美全髋关节和膝关节置换术（TJA）的比率有所增加。虽然最初是为 70 岁以上的老年患者设计的，但有几项报告表明，越来越多的年轻患者正在接受关节置换。这表明更多的人更早地满足了 TJA 的适应症。或者，这可能表明 TJA 的适应症范围更广。
我们使用医疗保健成本和利用项目（HCUP）和临床评估科学研究所（ICES）提供的管理数据库，分别确定了美国和加拿大安大略省 TJA 的髋关节和膝关节置换率。我们确定了这两个地区四个日历年内（2001 年、2003 年、2005 年和 2007 年）THA 和 TKA 的粗发病率。我们还计算了每个时期这两个地区 THA 和 TKA 的年龄和性别标准化发病率。我们比较了美国和安大略省 TJA 接受者的年龄分布，并在每个地区随时间进行比较。
在美国和安大略省，THA 和 TKA 的粗发病率和标准化发病率均随时间而增加。2001 年和 2003 年，美国 THA 的粗发病率较高，但与 2005 年和 2007 年安大略省的发病率没有显著差异。所有时期，美国 TKA 的粗发病率均较高。此外，在美国，“年轻”年龄组（<60 岁）的 THA 和 TKA 接受者人数始终较多。尽管所有时期美国 TKA 的年龄和性别标准化发病率均较高，但从 2001 年到 2007 年，安大略省的发病率增长幅度更大（美国为 59%，安大略省为 73%）。对于美国和安大略省来说，THA 和 TKA 接受者的人口统计学特征都向年轻患者转移（p < 0.0001）。
在 2001 年至 2007 年期间，美国和安大略省的初次髋关节和膝关节置换术的使用率都有了大幅增加。这种增加主要是膝关节置换术的增加。关节置换接受者的人口统计学特征变得更年轻，接受 TJA 的<60 岁患者的患病率大幅增加，并且在这两个地区，该年龄组的 TJA 发病率在普通人群中也显著增加。
