Projected Case Volume and Economic Burden of Knee Aseptic Loosening in Inpatient Total Knee Arthroplasty in the United States.

Abstract

Aseptic loosening after total knee arthroplasty (TKA) is an important complication often requiring revision surgery. The purpose of this study was to characterize and project the annual incidence and associated total inpatient costs of revision TKA (rTKA) for aseptic loosening. Admissions for rTKA performed for aseptic loosening between 2012 and 2022 were identified in a nationally representative sample of hospital admissions in the United States. Patients who were under 18 years of age and those who had concurrent infections were excluded. The estimated national incidence of rTKA for aseptic loosening and the associated economic burden in years 2012 to 2022 were identified. Future costs associated with aseptic loosening were projected to 2032. Costs were adjusted for inflation to a base year of 2022. In 2012, the earliest year under analysis, national admission volume was 15,355, rising to 18,775 by 2018. Volumes fell sharply during the pandemic. The average cost of admission rose from $30,920 in 2012 to $34,748 in 2022. Using 2012 to 2019 (pre-pandemic) data, the annual national volume of rTKA for aseptic loosening is projected to be 30,605 admissions per year by 2032, nearly double the volume in 2012. Costs per case were also projected to rise to $40,549 by 2032, a 31% increase from 2012. Total costs were projected to rise to $927,096,500 per year by 2032, a 95% increase from 2012. Aseptic loosening following TKA remains a contemporary issue with substantial associated treatment costs. Projections indicate that the annual inpatient cost of treating this condition will approach one billion dollars per year in the United States alone. Rising costs and deferred cases from the pandemic pose major challenges for orthopaedic surgeons and the healthcare system. Continued efforts aimed at preventing loosening are warranted.