Total knee arthroplasty on the rise in younger patients: Are we sure that past performance will guarantee future success?

Knee osteoarthritis (OA) is a highly prevalent and disabling problem affecting nearly 10 million adults in the United States.(1) As currently available therapies do not reverse cartilage loss and other structural abnormalities associated with OA, the disease process may progress insidiously. Many patients with advanced OA become candidates for total knee arthroplasty (TKA).TKA is remarkably effective, with perioperative mortality less than 1%, annual rates of failure leading to revision of less than 1%, and rates of symptom relief exceeding 85%.(2, 3) Over 600,000 TKAs were performed in the US in 2009, with inpatient costs exceeding $9 billion.(4) Utilization of TKA is likely to increase further.