Archives of Orthopaedic and Trauma Surgery

, Volume 130, Issue 5, pp 633–639

Geographical variation in incidence of primary total hip arthroplasty: a population-based analysis of 34,642 replacements

  • Keijo T. Mäkelä
  • Mikko Peltola
  • Unto Häkkinen
  • Ville Remes
Orthopaedic Surgery



Considerable variation in total hip arthroplasty (THA) incidence between regions has been described. The aim of this study was to evaluate geographical variation in the incidence of primary THA for OA in Finland and to analyze variables associated with this variation.


Using Hospital Discharge Register, 34,642 THAs performed for primary OA over the 1998 and 2005 period were identified. Incidence indices for 21 hospital administrative regions were determined. Logistic regression analysis and generalized linear models were used for studying the association of potential explanatory factors for the variation in the incidence of THA.


Incidence indices of THA varied from 1.9- to 3.0-fold during the study period. A high ratio of primary THA for primary OA to primary THA for any reason was associated with a high absolute incidence of primary THA (P < 0.001). Neither average incomes nor morbidity were associated with the incidence of THA.


When hip surgery was performed on a larger scale, threshold for performing THAs due to primary OA was higher. Socio-economic status had no apparent effect on THA rate. Surgeon decision-making related factors influence THA rates when there are only a few surgeons responsible for performing THAs in a region.


Total hip arthroplasty Variation of incidence Population-based 

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Keijo T. Mäkelä
    • 1
  • Mikko Peltola
    • 2
  • Unto Häkkinen
    • 2
  • Ville Remes
    • 3
  1. 1.Department of Orthopaedics and TraumatologyTurku University Central HospitalTurkuFinland
  2. 2.The National Institute for Health and WelfareHelsinkiFinland
  3. 3.Department of Orthopaedics and TraumatologyPeijas Hospital, Helsinki University Central HospitalHelsinkiFinland

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