JOA - 2026-07-24 - Journal Article
Projected Case Volume and Economic Burden of Knee Aseptic Loosening in Inpatient Total Knee Arthroplasty in the United States.
Pisharody VA, Nour G, Chowdary AR, Ross B, Erens GA, Premkumar A, Wilson JM
Topics
Key Takeaway
Revision TKA for aseptic loosening is projected to reach 30,605 cases/year by 2032, with total inpatient costs approaching $927 million annually—a 95% increase from 2012.
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Summary
Using a nationally representative inpatient database, this study quantified annual rTKA admissions for aseptic loosening from 2012–2022 and projected volumes and costs to 2032. National admission volume rose from 15,355 in 2012 to 18,775 in 2018 before pandemic-related decline; cost per admission rose from $30,920 to $34,748 over the same period. Pre-pandemic trend modeling projects 30,605 annual cases and $927 million in total inpatient costs by 2032.
Key Limitation
Projections rely on pre-pandemic (2012–2019) linear trends and cannot account for deferred pandemic cases, shifts toward outpatient TKA (excluded from inpatient database), or improvements in implant fixation that may alter future loosening rates.
Original Abstract
INTRODUCTION
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.
METHODS
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.
RESULTS
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.
CONCLUSIONS
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.