International Orthopaedics

, Volume 43, Issue 1, pp 133–138 | Cite as

Total knee arthroplasty in Italy: reflections from the last fifteen years and projections for the next thirty

  • Emilio RomaniniEmail author
  • Francesco Decarolis
  • Ilaria Luzi
  • Gustavo Zanoli
  • Michele Venosa
  • Paola Laricchiuta
  • Eugenio Carrani
  • Marina Torre
Original Paper



Annual rates of knee arthroplasty are increasing in all developed countries, imposing a significant economic and organizational burden; it is crucial to forecast the future need for knee arthroplasty, to assist stakeholders in planning strategies and investments, especially in a country like Italy, with the largest proportion of elderly citizens in Europe. Few epidemiological studies have been performed worldwide to estimate the demand for future knee replacement, and a variety of methods have been proposed.


We investigated the epidemiology of knee arthroplasty performed in Italy in the last 15 years and projected incidence rates up to the year 2050, utilizing, comparing, and adapting the available methodologies.


From 2001 to 2016, 812,639 primary TKA were performed in Italy on patients over 40. The total number of surgeries increased by 262% with an average annual growth rate of 6.6%.


Adopting the best fitting projection method, an increase of 45% in incidence rate is expected for 2050.


Total knee arthroplasty Epidemiology Projections Hospital discharge data 



The authors wish to thank Mascia Masciocchi and Stefania Ceccarelli.

Authors’ contributions

Conception and design (ER, MT), acquisition of data (MT, IL, PL), statistical analysis (FD, EC), drafting of the article (ER, MT, FD, GZ, MV). All authors interpreted results, revised critically, and approved the final version of the manuscript.


Francesco Decarolis thankfully acknowledges financial support from the European Research Council (ERC Starting Grant 679217).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

The design of this study did not require any informed consent.


  1. 1.
    Wallace IJ, Worthington S, Felson DT, Jurmain RD, Wren KT, Maijanen H, Woods RJ, Lieberman DE (2017) Knee osteoarthritis has doubled in prevalence since the mid-20th century. Proc Natl Acad Sci U S A 114(35):9332–9336CrossRefGoogle Scholar
  2. 2.
    Kiadaliri AA, Lohmander LS, Moradi-Lakeh M, Petersson IF, Englund M (2018) High and rising burden of hip and knee osteoarthritis in the Nordic region, 1990-2015. Acta Orthop 89(2):177–183CrossRefGoogle Scholar
  3. 3.
    Falez F (2014) Knee arthroplasty today. Int Orthop 38(2):221–225CrossRefGoogle Scholar
  4. 4.
    Schiavone Panni A, Falez F, D'Apolito R, Corona K, Perisano C, Vasso M (2017) Long-term follow-up of a non-randomised prospective cohort of one hundred and ninetytwo total knee arthroplasties using the NexGen implant. Int Orthop 41(6):1155–1162CrossRefGoogle Scholar
  5. 5.
    Leskinen J, Eskelinen A, Huhtala H, Paavolainen P, Remes V (2012) The incidence of knee arthroplasty for primary osteoarthritis grows rapidly among baby boomers: a population-based study in Finland. Arthritis Rheum 64(2):423–428CrossRefGoogle Scholar
  6. 6.
    Kurtz SM, Ong KL, Lau E, Widmer M, Maravic M, Gómez-Barrena E, de Pina Mde F, Manno V, Torre M, Walter WL, de Steiger R, Geesink RG, Peltola M, Röder C (2011) International survey of primary and revision total knee replacement. Int Orthop 35(12):1783–1789CrossRefGoogle Scholar
  7. 7.
    Pabinger C, Lothaller H, Portner N, Geissler A (2018) Projections of hip arthroplasty in OECD countries up to 2050. Hip Int 1:1120700018757940Google Scholar
  8. 8.
    Mazzola P, Rimoldi SM, Rossi P, Noale M, Rea F, Facchini C, Maggi S, Corrao G, Annoni G (2016) Aging in Italy: the need for new welfare strategies in an old country. Gerontologist 56(3):383–390CrossRefGoogle Scholar
  9. 9.
    Inacio MCS, Paxton EW, Graves SE, Namba RS, Nemes S (2017) Projected increase in total knee arthroplasty in the United States - an alternative projection model. Osteoarthr Cartil 25(11):1797–1803CrossRefGoogle Scholar
  10. 10.
    Nemes S, Rolfson O, W-Dahl A, Garellick G, Sundberg M, Kärrholm J, Robertsson O (2015) Historical view and future demand for knee arthroplasty in Sweden. Acta Orthop 86(4):426–431CrossRefGoogle Scholar
  11. 11.
    Torre M, Romanini E, Zanoli G, Carrani E, Luzi I, Leone L, Bellino S (2017) Monitoring outcome of joint arthroplasty in Italy: implementation of the National Registry. Joints 5:70–78CrossRefGoogle Scholar
  12. 12.
    Moran CG, Horton TC (2000) Total knee replacement: the joint of the decade. A successful operation, for which there's a large unmet need. BMJ 320(7238):820CrossRefGoogle Scholar
  13. 13.
    Nemes S, Gordon M, Rogmark C, Rolfson O (2014) Projections of total hip replacement in Sweden from 2013 to 2030. Acta Orthop 85(3):238–243CrossRefGoogle Scholar
  14. 14.
    Digennaro V, Zambianchi F, Marcovigi A, Mugnai R, Fiacchi F, Catani F (2014) Design and kinematics in total knee arthroplasty. Int Orthop 38(2):227–233CrossRefGoogle Scholar
  15. 15.
    Gaillard R, Cerciello S, Lustig S, Servien E, Neyret P (2017) Risk factors for tibial implant malpositioning in total knee arthrosplasty-consecutive series of one thousand, four hundred and seventeen cases. Int Orthop 41(4):749–756CrossRefGoogle Scholar
  16. 16.
    Benazzo F, Ghiara M, Rossi SMP, Pruneri E, Tiwari V, Perelli S (2018) Clinical and radiological analysis of a personalized total knee arthroplasty system design. Int Orthop.
  17. 17.
    d'Amato M, Ensini A, Leardini A, Barbadoro P, Illuminati A, Belvedere C (2018) Conventional versus computer-assisted surgery in total knee arthroplasty: comparison at ten years follow-up. Int Orthop.
  18. 18.
    Torre M., Luzi I, Carrani E, Leone L, Romanini E, Zanoli G (2014) Progetto registro Italiano Artroprotesi. Primo Report. Idea, sviluppo e avvio. Roma; Il Pensiero Scientifico EditoreGoogle Scholar
  19. 19.
    Cross M, Smith E, Hoy D, Nolte S, Ackerman I, Fransen M, Bridgett L, Williams S, Guillemin F, Hill CL, Laslett LL, Jones G, Cicuttini F, Osborne R, Vos T, Buchbinder R, Woolf A, March L (2014) The global burden of hip and knee osteoarthritis: estimates from the global burden of disease 2010 study. Ann Rheum Dis 73(7):1323–1330CrossRefGoogle Scholar
  20. 20.
    Inacio MCS, Graves SE, Pratt NL, Roughead EE, Nemes S (2017) Increase in total joint arthroplasty projected from 2014 to 2046 in Australia: a conservative local model with international implications. Clin Orthop Relat Res 475(8):2130–2137CrossRefGoogle Scholar
  21. 21.
    Kurtz SM, Ong KL, Lau E, Bozic KJ (2014) Impact of the economic downturn on total joint replacement demand in the United States: updated projections to 2021. J Bone Joint Surg Am 96(8):624–630CrossRefGoogle Scholar
  22. 22.
    Kurtz S, Ong K, Lau E, Mowat F, Halpern M (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 89(4):780–785Google Scholar
  23. 23.
    Pilz V, Hanstein T, Skripitz R (2018) Projections of primary hip arthroplasty in Germany until 2040. Acta Orthop 89(3):308–313CrossRefGoogle Scholar
  24. 24.
    Culliford D, Maskell J, Judge A, Cooper C, Prieto-Alhambra D, Arden NK, COASt Study Group (2015) Future projections of total hip and knee arthroplasty in the UK: results from the UK clinical practice research datalink. Osteoarthr Cartil 23(4):594–600CrossRefGoogle Scholar
  25. 25.
    Robertsson O, Dunbar MJ, Knutson K, Lidgren L (2000) Past incidence and future demand for knee arthroplasty in Sweden: a report from the Swedish knee arthroplasty register regarding the effect of past and future population changes on the number of arthroplasties performed. Acta Orthop Scand 71(4):376–380CrossRefGoogle Scholar
  26. 26.
    Baglio G, Sera F, Cardo S, Romanini E, Guasticchi G, Labek G, Torre M (2009) The validity of hospital administrative data for outcome measurement after hip replacement. Italian Journal of Public Health 7(6):12–24Google Scholar
  27. 27.
    Cimmino MA, Scarpa R, Caporali R, Parazzini F, Zaninelli A, Sarzi-Puttini P (2013) Body mass and osteoarthritic pain: results from a study in general practice. Clin Exp Rheumatol 31(6):843–849Google Scholar
  28. 28.
    Gallus S, Lugo A, Murisic B, Bosetti C, Boffetta P, La Vecchia C (2015) Overweight and obesity in 16 European countries. Eur J Nutr 54(5):679–689CrossRefGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  1. 1.GLOBE, Italian Working Group on Evidence Based OrthopaedicsRomeItaly
  2. 2.ArtrogruppoCasa di Cura San FelicianoRomeItaly
  3. 3.Università BocconiMilanItaly
  4. 4.National Centre for Clinical Excellence, Safety and Quality of CareIstituto Superiore di SanitàRomeItaly
  5. 5.Casa di Cura Santa Maria MaddalenaOcchiobelloItaly

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