Non-Hispanic whites make up the vast majority of patients who undergo total hip and knee replacements. The main reason for this, explained Dr. Sloan, is that they are the largest demographic segment by proportion in the United States. However, they are disproportionately undergoing total joint replacement relative to their percentage of the population.
In 2014, non-Hispanic whites made up 62% of the U.S. population, but underwent 86% of the THR and 82% of the TKR procedures. The second-most common group to undergo these procedures were blacks, who made up 13% of the U.S. population in 2014 and accounted for 8% of the patients undergoing THR and TKR.
Even more under-represented were Hispanics, making up 18% of the U.S. population and only 3% of THR and 6% of TKR procedures, followed by Asians who made up 6% of the U.S. population and 1% of the procedures, Dr. Sloan said.
It’s not possible to know the reasons for these differences from the raw data, “but one would assume a main driver is access to care. Access to surgeons and insurance to pay for surgical treatment may be more common among non-Hispanic whites than other racial groups. Further, there may be cultural or social differences among groups that cause non-Hispanic whites to pursue surgical treatments, while Asians seem to avoid surgery,” Dr. Sloan said.
Total joint replacement is one of the most commonly performed elective surgical procedures in the United States. According to NIS data, in 2014, there were more than 370,000 THR and 680,000 TKR surgeries.
Based on a predictive model that Drs. Sloan and Sheth developed, by 2030, primary THR is projected to reach 635,000 (171% increase) and primary TKR, 1.28 million (189% increase). Similar increases are expected for revision THR and TKR.
“These numbers are always changing,” Sloan noted in a conference statement. “We will continue to look at new data as the numbers need to be constantly updated, especially if they are used to make predictions for future healthcare saving decisions, as the impact can be in the millions of dollars. It’s imperative to provide policy makers with high-quality data to inform decisions that will affect patient access to orthopaedic care and the financial viability of elective orthopedic procedures.”
- Sloan M, Sheth NP. Projected orthopaedic surgeon workforce shortfall for primary and revision total joint arthroplasty procedures, 2030–2060. American Society of Orthopaedic Surgeons’ Annual Meeting. 2018 Mar 8.