Ann Rheum Dis 62:222-226 doi:10.1136/ard.62.3.222
  • Extended report

International variation in hip replacement rates

  1. H Merx1,
  2. K Dreinhöfer1,
  3. P Schräder1,
  4. T Stürmer2,
  5. W Puhl1,
  6. K-P Günther1,
  7. H Brenner2
  1. 1Department of Orthopaedics (RKU), University of Ulm, D 89081 Ulm, Germany
  2. 2Department of Epidemiology, German Centre for Research on Aging, D 69115 Heidelberg, Germany
  1. Correspondence to:
    Dr K-P Günther, Department of Orthopaedics (RKU), University of Ulm, Oberer Eselsberg 45, D 89081 Ulm, Germany;
  • Accepted 3 July 2002


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.