Authors
Jakob Adolf, Taner Karlıdağ, Mustafa Citak
Published in
The Journal of bone and joint surgery. American volume. Sep 30, 2026. Epub Sep 30, 2026.
Abstract
The expanding pool of primary hip and knee arthroplasty implants in situ will generate a growing burden of revision arthroplasty. Projections for several individual countries have been published, but heterogeneous methods and time horizons prevent direct aggregation. We used a uniform method to estimate annual revision total hip arthroplasty (rTHA) and revision total knee arthroplasty (rTKA) volumes through 2060 for 17 registry-equipped countries.
Annual rTHA and rTKA counts were extracted from each country's most recent register annual report or registry-based publications. Adult (≥25 years) population denominators were taken from the UN World Population Prospects 2024 medium variant. For each country and procedure, we fitted a log-linear Poisson generalized linear model with the year as a covariate and ln(population) as an offset; each fitted trend was partially pooled across countries, bounded at ±2.0% per year, and damped over the projection horizon. Three sensitivity analyses (demographic-only, half-trend Poisson, logistic saturation) were also performed to bracket modeling uncertainty.
In 2024, the modeled 17-country aggregate was 185,921 rTHA and 189,689 rTKA procedures. Under the primary capped Poisson model, the 2060 aggregate reached 243,404 rTHAs and 267,456 rTKAs, corresponding to increases of 31% and 41%, respectively, relative to 2024. Country-level volume trajectories were heterogeneous: the United States and People's Republic of China drove most absolute growth, while Germany, the United Kingdom, and Sweden approached plateaus by mid-century and Japan was projected to have a decline. The 4 projection methods spanned 2060 combined volumes of ⁓461,000 (demographic-only) to ⁓511,000 (primary model) procedures.
Across 17 countries that perform most of the world's hip and knee arthroplasties, annual revision volumes are projected to grow by approximately one-third (36% in aggregate; 31% for rTHA and 41% for rTKA) by 2060 under the primary model. The United States and China account for the largest absolute growth; mature European systems flatten, and Japan declines. These projections have direct implications for revision-fellowship pipelines, perioperative infection-prevention programs, and registry infrastructure.
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
PMID:
42814846
Bibliographic data and abstract were imported from PubMed on 01 Oct 2026.
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