Background: From several decades, the evolutions of the Incidence Rate (IR) of Primary Knee Arthroplasties are continuously increasing worldwide and have been widely studied in several countries. Some recent works have highlighted the fact that the IR is following a sigmoid curve composed of an exponential growth followed by a linear phase and finished by a plateau. Our objective is to assess the IR evolution of eleven European countries, representing thus a large proportion of this continent, regarding this sigmoid. Methods: IRs of primary knee arthroplasties for Austria, Denmark, Finland, France, Germany, Hungary, Italy, Poland, Spain, Sweden, and the United Kingdom between 2005 and 2019 were retrieved from the EUROSTAT database. Several regression models were fitted to each country’s IRs: Poisson, linear, asymptotic, logistic, and Gompertz regression. For each country and each model, the RMSE (Root Mean Square Error) and R² were calculated and used to estimate their position with respect to this sigmoid curve. Results: The best regression models for knee arthroplasties varied following countries. Logistic and Gompertz regressions had the lowest RMSE and R2 values for Austria, Denmark, Germany, Sweden, and the UK. Hungary, Italy, and Poland favored the Poisson regression model. Finland and Spain presented difficulties in determining the optimal model (linear or Poisson), while France faced challenges in choosing between logistic, Gompertz, and linear regression. Conclusion: In conclusion, the growth dynamics of IR differ across European countries. Some countries seem to have already reached a plateau and will therefore experience slight growth in the future.

Three-dimensional printing is a technology that has been developed and applied in several medical specialties, especially orthopedic surgery. Knee arthroplasty is the most commonly performed procedure. To fit the morphology of each knee, surgeons can choose between different standardized off-the-shelf implant sizes or opt for customized 3D-printed implants. However, routine adoption of the latter has been slow and faces several barriers. Existing studies focus on technical improvements or case studies and do not directly address the surgeon’s perspective. Our study invited surgeons to express themselves freely and answer the question “What do you think about the manufacture of a prosthesis by 3D printing?”. The questionnaire was completed by 90 surgeons. On average, they had more than 10 years of experience (52, 57.8% ± 10.2%), worked in public hospitals (54, 60% ± 10.1%), and performed between 0 and 100 prostheses per year (60, 66.7% ± 9.7%). They also reported not using planning software (47, 52.2% ± 9.7%), navigation systems, or robots (62, 68.9% ± 9.6%). Regarding the use of technological innovation, they agreed on the extra surgical time needed (67, 74.4% ± 9.0%). The answers obtained were classified according to two criteria: (i) opinions, and (ii) motivations. Among the respondents, 51 (70% ± 9.5%) had positive and 22 (30% ± 9.5%) had negative opinions about 3D printing. The motivations were distributed among seven categories (surgery, materials, costs, logistics, time, customization, and regulatory) and mainly related to “pre-surgery” and “post-surgery” concerns. Finally, the results showed that the use of navigation systems or robots may be associated with a more positive view of 3DP. The purpose of our study was to examine knee surgeons’ perceptions of 3DP at a time of significant expansion of this technology. Our study showed that there was no opposition to its implementation, although some surgeons indicated that they were waiting for validated results. They also questioned the entire supply chain, including hospitals, insurance companies, and manufacturers. Although there was no opposition to its implementation, 3D printing is at a crucial point in its development and its full adoption will require advances in all areas of joint replacement.

To address the increasing global demand for Total Knee Arthroplasty and reduce the need for revisions, several technologies combining 3D planning and artificial intelligence have emerged. These innovations aim to enhance customization, improve component positioning accuracy and precision. The integration of these advancements paves the way for the development of personalized and connected knee implant. These groundbreaking advancements may necessitate changes in surgical practices. Hence, it is important to comprehend surgeons' intentions in integrating these technologies into their routine procedures. Our study aims to assess how surgeons' preferences will affect the acceptability of using this new implant and associated technologies within the entire care chain. We employed a Discrete Choice Experiment, a predictive technique mirroring real-world healthcare decisions, to assess surgeons' trade-off evaluations and preferences. A total of 90 experienced surgeons, performing a significant number of procedures annually (mostly over 51) answered. Analysis indicates an affinity for technology but limited interest in integrating digital advancements like preoperative software and robotics. However, they are receptive to practice improvements and considering the adoption of future sensors. In conclusion, surgeons prefer customized prostheses via augmented reality, accepting extra cost. Embedded sensor technology is deemed premature by them.

La chirurgie de remplacement articulaire par prothèse du genou est devenue courante dans de nombreux pays, avec une augmentation constante du nombre d'implants posés. Plusieurs facteurs, comme le vieillissement de la population, l'amélioration des résultats chirurgicaux et la qualité des implants, ainsi que les attentes de patients jeunes atteints d'arthrose précoce, expliquent cette tendance. Face aux défis futurs liés à la croissance attendue, et à l'augmentation prévisible des coûts de prise en charge, des innovations systémiques et techniques sont indispensables. Les acteurs de l'industrie de la santé et les chercheurs s'efforcent donc constamment d'améliorer les technologies et les processus. C'est dans ce contexte que le projet FollowKnee a été initié, visant à repenser la chaîne de soins actuelle en concevant une prothèse personnalisée et connectée. La présente thèse interroge donc les origines de cette croissance et les préférences des chirurgiens vis-à-vis de ces technologies disruptives. L’analyse épidémiologique des arthroplasties du genou montre une croissance mondiale hétérogène entre les pays. Elle résulte de combinaisons de causes étiologiques et de facteurs exogènes comme les améliorations technologiques, les politiques publiques ou les recommandations médicales. En conséquence, plusieurs typologies de croissance sont observées. L’analyse des préférences révèle une perception positive et un souhait d’utilisation de ces nouvelles technologies, dont, l’usage reste toutefois dépendant du contexte de travail et du degré de maturité. En conclusion, cette thèse montre l’intérêt d’une évolution technologique, en réponse à la croissance observée et prévue.