Title : Projections of High Tibial Osteotomy (HTO), Unicompartmental Knee Arthroplasty (UKA), and primary Total Knee Arthroplasty (TKA) in the United States From 2020 to 2050
Abstract:
Introduction: While primary Total Knee Arthroplasty (TKA) remains the most common and definitive treatment for advanced knee arthritis, there is growing interest in joint-preserving procedures such as High Tibial Osteotomy (HTO) and Unicompartmental Knee Arthroplasty (UKA), particularly among younger, active patients with isolated compartment disease. However, long-term projections for surgical procedures commonly used in the management of knee osteoarthritis remain limited. The purpose of this study was to analyze national trends in HTO, UKA, and TKA, and project the utilization of these procedures in the United States through 2050.
Methods: Procedural data for TKA, UKA, and HTO from 2000 to 2019 were obtained from the Medicare Part B database. After evaluating several statistical models, the Auto Regressive Integrated Moving Average (ARIMA) model was selected based on the lowest normalized root mean square error, a robust measure of forecast accuracy. This model was subsequently used to project annual
procedure volumes through 2050.
Results: In 2019, Medicare Part B data recorded 444,270 TKA procedures, 30,002 UKA procedures, and 734 HTO procedures. ARIMA modeling projected continued growth across all three techniques through 2050. TKA is estimated to increase at a compounded annual growth rate of 2.14%, reaching 883,306 procedures by 2050 (95% CI: 830,818–935,997). UKA is projected to grow at 2.07% annually, with an estimated volume of 58,571 procedures by 2050 (95% CI: 49,397–67,178). HTO is expected to increase at a rate of 3.06% per year, reaching 1,918 procedures by 2050 (95% CI: 1,463–2,748).
Conclusion: Relative to the annual volume reported by Medicare in 2020, TKA and UKA are projected to increase by 92.82% and 88.49%, respectively, by 2050. Although HTO accounts for a small proportion of overall procedures, its projected 154.38% increase underscores its continued utility in select patients — particularly those with isolated single-compartment disease and varus malalignment. This trend may also reflect the growing use of HTO in slope-correcting osteotomies for ACL-deficient knees, where adjusting tibial slope can improve stability and reduce graft failure risk. Notably, this analysis is limited to older adults, likely underestimating broader HTO utilization in younger populations. These projections highlight the importance of long-term planning in surgical training, implant manufacturing, and healthcare infrastructure to meet the rising demand for knee osteoarthritis procedures.
