TRENDS IN TOTAL HIP AND KNEE REPLACEMENT SURGERY IN CANADA – DATA FROM THE CANADIAN JOINT REPLACEMENT REGISTRY

Introduction: The purpose of this study was to utilise data from the Canadian Joint Replacement Registry (CJRR) to determine trends in the 43,000 total hip and knee replacement surgeries performed annually in Canada. This data will promote improved access to care and evidence-based surgical practice. Total knee replacement in Canada is associated with greater utilisation rates, less morbidity, less re-admissions and lower satisfaction compared to total hip arthroplasty. Method: The Canadian Joint Replacement Registry is conducted by orthopaedic surgeons under the umbrella of the Canadian Orthopaedic Association, funded by Health Canada and administered by the Canadian Institute of Health Information. Inaugurated in 2000, the Canadian Joint Replacement Registry has issued three annual reports, which highlight trends in total hip and knee replacement in Canada over the past decade. Data from this voluntary Registry provide the data for this study. Results: THR and TKR utilisation in Canada increased by 34% from 1994–5 to 2000–01. Total knee replacement utilisation exceeded total hip replacement rates in the mid-1990s and increased TKR use continues to grow. Considerable provincial area variations exist with regards THR and TKR utilisation in Canada. THR and TKR are more commonly performed in female patients with peak utilisation being between 65 and 74 years of age. One third of THRs and TKRs are now performed on patients Average length of stay has dropped precipitously over the last two decades. Average length of stay is now approximately five days for THRs and TKRs. In-hospital mortality is higher for THRs (1.51%) as compared to TKRs (0.54%). Complications leading to readmission are more common in THRs. Age-standardised rates of THR and TKR/100,000 population have increased from 1994–5 to present, but are still lower than other countries. Waiting times for surgery remain a problem with most patients waiting more than six months for surgery. One year post-operatively, 96% of patients would have their primary or revision total hip or knee replacement performed again. Patients are more satisfied with the outcome of primary procedures as compared to revisions. THR patients have a higher level of satisfaction than TKR patients. Conclusion: THR and TKR utilisation are dynamic in nature. A national registry such as the CJRR is important in pooling large data sets, allowing trends to be recognised, influencing health care providers and promoting evidence-based surgical practice.

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