Skip to main content
PMC home page
Annals of the Rheumatic Diseases logoLink to Annals of the Rheumatic Diseases
. 2003 Mar;62(3):222–226. doi: 10.1136/ard.62.3.222

International variation in hip replacement rates

H Merx 1, K Dreinhofer 1, P Schrader 1, T Sturmer 1, W Puhl 1, K Gunther 1, H Brenner 1
PMCID: PMC1754456  PMID: 12594106

Abstract

Objectives: To summarise epidemiological data on the frequency of hip replacements in the countries of the developed world, especially in countries of the Organisation for Economic Cooperation and Development (OECD), and to investigate whether missing consensus criteria for the indication for total hip replacement (THR) result in different replacement rates.

Methods: Country-specific hip replacement rates were collected using the available literature, different data sources of national authorities, and estimates of leading hip replacement manufacturers.

Results: According to administrative and literature data sources the reported crude primary THR rate varied between 50 and 130 procedures/100 000 inhabitants in OECD countries in the 1990s. The crude overall hip implantation rate, summarising THR, partial hip replacement, and hip revision procedures, was reported to range from 60 to 200 procedures/100 000 inhabitants in the late 1990s. Moreover, large national differences were seen in the relationship between total and partial hip replacement procedures.

Conclusion: The reported differences in hip replacement rates in OECD countries are substantial. They may be due to various causes, including different coding systems, country-specific differences in the healthcare system, in total expenditure on health per capita, in the population age structure, and in different indication criteria for THR.

Full Text

The Full Text of this article is available as a PDF (148.6 KB).

Figure 1.

Figure 1

Open in a new tab

Hip implantation rate per 100 000 inhabitants and total expenditure on health per capita (1998).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bachmeier C. J., March L. M., Cross M. J., Lapsley H. M., Tribe K. L., Courtenay B. G., Brooks P. M., Arthritis Cost and Outcome Project Group A comparison of outcomes in osteoarthritis patients undergoing total hip and knee replacement surgery. Osteoarthritis Cartilage. 2001 Feb;9(2):137–146. doi: 10.1053/joca.2000.0369. [DOI] [PubMed] [Google Scholar]
  2. Badley E. M. The economic burden of musculoskeletal disorders in Canada is similar to that for cancer, and may be higher. J Rheumatol. 1995 Feb;22(2):204–206. [PubMed] [Google Scholar]
  3. Birrell F., Johnell O., Silman A. Projecting the need for hip replacement over the next three decades: influence of changing demography and threshold for surgery. Ann Rheum Dis. 1999 Sep;58(9):569–572. doi: 10.1136/ard.58.9.569. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Chang R. W., Pellisier J. M., Hazen G. B. A cost-effectiveness analysis of total hip arthroplasty for osteoarthritis of the hip. JAMA. 1996 Mar 20;275(11):858–865. [PubMed] [Google Scholar]
  5. Coyte P. C., Asche C. V., Croxford R., Chan B. The economic cost of musculoskeletal disorders in Canada. Arthritis Care Res. 1998 Oct;11(5):315–325. doi: 10.1002/art.1790110503. [DOI] [PubMed] [Google Scholar]
  6. Dunsmuir R. A., Allan D. B., Davidson L. A. Increased incidence of primary total hip replacement in rural communities. BMJ. 1996 Nov 30;313(7069):1370–1370. doi: 10.1136/bmj.313.7069.1370. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Gentleman J. F., Vayda E., Parsons G. F., Walsh M. N. Surgical rates in subprovincial areas across Canada: rankings of 39 procedures in order of variation. Can J Surg. 1996 Oct;39(5):361–367. [PMC free article] [PubMed] [Google Scholar]
  8. Gittelsohn A. M., Halpern J., Sanchez R. L. Income, race, and surgery in Maryland. Am J Public Health. 1991 Nov;81(11):1435–1441. doi: 10.2105/ajph.81.11.1435. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Havelin L. I., Espehaug B., Vollset S. E., Engesaeter L. B., Langeland N. The Norwegian arthroplasty register. A survey of 17,444 hip replacements 1987-1990. Acta Orthop Scand. 1993 Jun;64(3):245–251. doi: 10.3109/17453679308993618. [DOI] [PubMed] [Google Scholar]
  10. Havelin L. I. The Norwegian Joint Registry. Bull Hosp Jt Dis. 1999;58(3):139–147. [PubMed] [Google Scholar]
  11. Herberts P., Malchau H. How outcome studies have changed total hip arthroplasty practices in Sweden. Clin Orthop Relat Res. 1997 Nov;(344):44–60. [PubMed] [Google Scholar]
  12. Herberts P., Malchau H. Long-term registration has improved the quality of hip replacement: a review of the Swedish THR Register comparing 160,000 cases. Acta Orthop Scand. 2000 Apr;71(2):111–121. doi: 10.1080/000164700317413067. [DOI] [PubMed] [Google Scholar]
  13. Hirsch H. S. Total joint replacement: a cost-effective procedure for the 1990s. Med Health R I. 1998 May;81(5):162–164. [PubMed] [Google Scholar]
  14. Hoaglund F. T., Oishi C. S., Gialamas G. G. Extreme variations in racial rates of total hip arthroplasty for primary coxarthrosis: a population-based study in San Francisco. Ann Rheum Dis. 1995 Feb;54(2):107–110. doi: 10.1136/ard.54.2.107. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Ingvarsson T., Hägglund G., Jónsson H., Jr, Lohmander L. S. Incidence of total hip replacement for primary osteoarthrosis in Iceland 1982-1996. Acta Orthop Scand. 1999 Jun;70(3):229–233. doi: 10.3109/17453679908997798. [DOI] [PubMed] [Google Scholar]
  16. Ingvarsson T., Hägglund G., Lohmander L. S. Prevalence of hip osteoarthritis in Iceland. Ann Rheum Dis. 1999 Apr;58(4):201–207. doi: 10.1136/ard.58.4.201. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Jones C. A., Voaklander D. C., Johnston D. W., Suarez-Almazor M. E. Health related quality of life outcomes after total hip and knee arthroplasties in a community based population. J Rheumatol. 2000 Jul;27(7):1745–1752. [PubMed] [Google Scholar]
  18. Madhok R., Lewallen D. G., Wallrichs S. L., Ilstrup D. M., Kurland R. L., Melton L. J., 3rd Trends in the utilization of primary total hip arthroplasty, 1969 through 1990: a population-based study in Olmsted County, Minnesota. Mayo Clin Proc. 1993 Jan;68(1):11–18. doi: 10.1016/s0025-6196(12)60013-5. [DOI] [PubMed] [Google Scholar]
  19. March L. M., Bachmeier C. J. Economics of osteoarthritis: a global perspective. Baillieres Clin Rheumatol. 1997 Nov;11(4):817–834. doi: 10.1016/s0950-3579(97)80011-8. [DOI] [PubMed] [Google Scholar]
  20. Oishi C. S., Hoaglund F. T., Gordon L., Ross P. D. Total hip replacement rates are higher among Caucasians than Asians in Hawaii. Clin Orthop Relat Res. 1998 Aug;(353):166–174. doi: 10.1097/00003086-199808000-00019. [DOI] [PubMed] [Google Scholar]
  21. Okhuijsen S. Y., Dhert W. J., Faro L. M., Schrijvers A. J., Verbout A. J. De totaleheupprothese in Nederland. Ned Tijdschr Geneeskd. 1998 Jun 20;142(25):1434–1438. [PubMed] [Google Scholar]
  22. Overgaard S., Knudsen H. M., Hansen L. N., Mossing N. Hip arthroplasty in Jutland, Denmark. Age and sex-specific incidences of primary operations. Acta Orthop Scand. 1992 Oct;63(5):536–538. doi: 10.3109/17453679209154731. [DOI] [PubMed] [Google Scholar]
  23. Paavolainen P., Hämäläinen M., Mustonen H., Slätis P. Registration of arthroplasties in Finland. A nationwide prospective project. Acta Orthop Scand Suppl. 1991;241:27–30. doi: 10.3109/17453679109155101. [DOI] [PubMed] [Google Scholar]
  24. Seagroatt V., Tan H. S., Goldacre M., Bulstrode C., Nugent I., Gill L. Elective total hip replacement: incidence, emergency readmission rate, and postoperative mortality. BMJ. 1991 Dec 7;303(6815):1431–1435. doi: 10.1136/bmj.303.6815.1431. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Sun Y., Stürmer T., Günther K. P., Brenner H. Inzidenz und Prävalenz der Cox- und Gonarthrose in der Allgemeinbevölkerung. Z Orthop Ihre Grenzgeb. 1997 May-Jun;135(3):184–192. doi: 10.1055/s-2008-1039578. [DOI] [PubMed] [Google Scholar]
  26. Tate D., Jr, Sculco T. P. Advances in total hip arthroplasty. Am J Orthop (Belle Mead NJ) 1998 Apr;27(4):274–282. [PubMed] [Google Scholar]
  27. Towheed T. E., Hochberg M. C. Health-related quality of life after total hip replacement. Semin Arthritis Rheum. 1996 Aug;26(1):483–491. doi: 10.1016/s0049-0172(96)80029-1. [DOI] [PubMed] [Google Scholar]
  28. Williamson O. D. Measuring the success of joint replacement surgery. Med J Aust. 1999 Sep 6;171(5):229–230. doi: 10.5694/j.1326-5377.1999.tb123625.x. [DOI] [PubMed] [Google Scholar]
  29. Yelin E., Callahan L. F. The economic cost and social and psychological impact of musculoskeletal conditions. National Arthritis Data Work Groups. Arthritis Rheum. 1995 Oct;38(10):1351–1362. doi: 10.1002/art.1780381002. [DOI] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

[Web-only Figures and Table]
annrheumd_62_3_222__index.html (1.7KB, html)
annrheumd_62_3_222__1.pdf (93.7KB, pdf)
annrheumd_62_3_222__623222figurew1.gif (5.2KB, gif)
annrheumd_62_3_222__623222figurew2.gif (4.2KB, gif)

Articles from Annals of the Rheumatic Diseases are provided here courtesy of BMJ Publishing Group

RESOURCES