Background and purposeThe number of hip replacements in Germany has increased considerably during the last 2 decades but lately levelled off with no significant increase in operation rates. We analyzed the future trend of hip arthroplasty and projected the number of primary hip replacements that will be performed in Germany until 2040.Patients and methodsWe used prevalence data of hip arthroplasty patients from 2010 to 2016 from the nationwide inpatient statistics and population forecasts from the German Federal Bureau of Statistics up to the year 2040. We used Poisson regression to estimate the expected annual number of arthroplasty surgeries with calendar year and patient age as covariates to account for differences among age groups and changes over time.ResultsThe number of primary hip replacements performed in Germany in 2040 was estimated to grow by 27% to 288 x 103 (95% CI 250 x 103–332 x 103) from 2010. Projected counts were highest for patients aged 60 to 70 years. The estimated incidence rate was projected to 360 (95% CI 312–414) per 100,000 residents. However, incidence rates for individual age classes were found to be constant with a slight decrease over time for individual age classes.InterpretationOur findings suggest a growth in the total hip arthroplasty count whereas incidence rate remained constant over age classes. We consider the future demographic change to an older population as well as the increasing life expectancy to be the main reasons for the increasing patient numbers rather than a general increase in the operation frequency.

The current G-DRG reimbursement system paradoxically rewards slow-track intervals for two-stage revisions and jeopardizes the implementation of beneficial fast-track intervals in clinical routine. Patients treated with slow-track therapy experience longer and more debilitating treatment, accompanied by greater healthcare costs for both payers and hospitals. New treatment concepts which offer better care at lower cost should attract the attention of policy makers, clinicians, and the public.

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Total hip and knee replacements (THR, TKR) are among the most common surgeries but incidence rates vary between OECD countries. Previous studies suggested economic factors to be most influential but did not take into account health care system related factors. Hence we analysed the possible influence of healthcare system related factors on the operation rate. We used OECD data for 27 countries and calculated Age-Standardized Incidence Rates (ASIR). In order to determine possible explanatory variables on the ASIRs we performed a stepwise blockwise linear regression. The ASIR of hip and knee replacement varies widely. We identified statistically significant determinants which influence the ASIR of THR in a positive manner: incidence and length of stay of coxarthrosis, ASIR of knee replacement, health expenditures, number of nurses and an etatistic social insurance. Diabetes prevalence, gross domestic product and number of doctor consultations, however, have a negative influence on the ASIR. TKR rate is positively influenced by health expenditures and incidence rate of gonarthrosis, negatively by the number of primary practitioners. We observed strong geographic disparities in the frequency of THR and THR that cannot be explained by age structure of the countries. Economic factors seem to play a secondary role while healthcare related factors have a greater influence.