Proliance Orthopedic Associates

2021 American Joint Replacement Registry (AJRR) Annual Report on Hip and Knee Replacement in the United States

As we near the end of another year, it is imperative to look back and examine the results of the implants we use to perform hip and knee replacements in our patients. The AJRR gives us the opportunity to exam trends in joint replacement, follow specific implant survival rates, and compare our institutions results with other sites around the country. The data from calendar year 2020 showed the dramatic impact of the COVID pandemic on hip and knee replacement in the US. From mid-March to mid-May there was a dramatic decline in elective hip and knee replacement surgery. Patients and surgeons put their schedules on hold, but a brisk rebound happened in the Summer of 2020. (Figure 1.1) As the pandemic has waxed and waned so, too, have elective hip and knee replacements. This has led to a dramatic increase in same day discharges from hospitals and Ambulatory Surgery Centers (ASCs). (Figure 1.2)

Trends in hip replacements: Anterior Approach Hip Replacement continues to grow in popularity now, accounting for over 40% of cases in the US. I have previously written about the advantages of this approach. Cementless fixation of the stem and cup is used in over 90% of cases. The most common bearing combination in 2021 has been a ceramic ball on a crosslinked polyethylene liner.

Trends in knee replacements: Cemented fixation of knee replacements is still the most common method used, but cementless fixation is growing in popularity especially in younger males who can put more stress on the fixation of implants. There is increasing use of robotic surgery in knee replacement, with 60% of respondents at our recent annual meeting of hip and knee surgeons stating they have robotic options in their hospitals.

I have had the privilege of being involved in the design of one of the most widely used cups (Acetabular Component in THA) in the world, the Pinnacle Cup (DePuySynthes), as well as a total knee system the Attune Total Knee (DePuySynthes). It was with great interest and pride that I noted the Pinnacle cup was the most used cup in the AJRR 2021 data and also had the lowest failure rate among the most commonly used cups in the US. We use this implant in all of our hip replacements. The most recent Australian and United Kingdom registries found the Attune total knee to have the best-in-class survivorship. We use this implant system for our total knee patients.

So what does the future hold? We are opening our new joint venture ASC with Valley Medical Center on Dec. 15th, 2021. We are excited to offer a state-of-the-art outpatient surgery center for hip and knee replacement surgery. We will continue and expand our teaching capabilities to educate surgeons on the use of anterior hip replacement, use of robotic knee replacement and revision hip and knee replacement.