Reevaluating Projections: Total Knee Arthroplasty Volume Before and After COVID-19 in a Single Orthopedic Practice

The increasing demand for primary (pTKA) and revision total knee arthroplasty (rTKA) has been well documented, with previous literature projecting growth through the year 2030. However, the COVID-19 pandemic introduced a significant disruption to healthcare delivery, and its long-term impact on arthroplasty volume trends remains unclear. This study examines the trajectory of pTKA and rTKA volumes in a high-volume private orthopedic practice before and after the pandemic to assess potential lasting effects.

This retrospective observational study included 11,589 pTKA and 857 rTKA procedures performed between January 1, 2018, and December 31, 2023. Quarterly volumes were analyzed using segmented interrupted time-series regression, with Q2 2020 (April-June) defined as the interruption. Models estimated the preinterruption trend, immediate level change, change in slope, and postinterruption trend using Newey-West standard errors. Sensitivity analyses excluded Q2 2020, modeled it as a temporary shutdown, and adjusted for calendar-quarter seasonality.

The preinterruption pTKA trend was +1.30 procedures per quarter (95% CI, -6.61-9.21; p = 0.735). At Q2 2020, pTKA volume decreased immediately by 90.33 procedures (95% CI, -156.21--24.45; p = 0.010). The postinterruption slope was +11.67 procedures per quarter (95% CI, 4.93-18.40; p = 0.002); however, the change from the preinterruption slope was not statistically significant (+10.37 procedures per quarter; 95% CI, -2.08-22.82; p = 0.098). The positive postrecovery pTKA slope persisted after excluding Q2 2020. No significant immediate level or slope changes were identified for rTKA, including a postinterruption slope of +0.63 procedures per quarter (95% CI, -0.68-1.93; p = 0.328).

Within this single private orthopedic practice, the pandemic interruption was associated with an immediate reduction in pTKA volume followed by a positive postinterruption trend. However, the formal change from the pre-interruption slope was not statistically significant, and no significant trend changes were identified for rTKA. These findings represent temporal associations and may also reflect deferred care, outpatient migration, expanded ambulatory capacity, and other contemporaneous practice or policy changes.