Skip to main content
SpringerLink
Log in

Future burden of primary and revision hip arthroplasty in Germany: a socio-economic challenge

  • Hip Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Total hip arthroplasty (THA) rates have increased dramatically in the recent decades worldwide, with Germany being one of the leading countries in the prevalence of THA. Simultaneously, a rising number of revision procedures is expected, which will put an enormous economic burden on future health care systems.

Methods

Nationwide data provided by the Federal Statistical Office of Germany were used to quantify primary and revision arthroplasty rates as a function of age and gender. Projections were performed with use of Negative Binomial and Poisson regression models on historical procedure rates in relation to population projections from 2020 to 2060.

Results

A 62% increase in the incidence rate of primary THAs is projected until 2060. At the same time, the annual total number of revision procedures is forecast to rise about 40% by the year 2060. The highest numbers of revision arthroplasties were calculated around year 2043. The greatest proportions of revision surgery will be observed in women and in those aged 70 years or older. The revision burden is projected to stabilize around 15% by 2060.

Conclusions

The present projections allow a quantification of the increasing economic burden that (revision) THA will place on the German health care system in the upcoming decades. This study may serve as a model for other countries with similar demographic development as the country-specific approach predicts a substantial increase in the number of these procedures. This highlights the need for appropriate financial and human resource management in the future.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Inacio MCS, Graves SE, Pratt NL, Roughead EE, Nemes S (2017) Increase in total joint arthroplasty projected from 2014 to 2046 in Australia: a conservative local model with international implications. ClinOrthopRelat Res 475(8):2130–2137

    Google Scholar 

  2. Kurtz S, Ong K, Lau E, Mowat F, Halpern M (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone JtSurg Am 89(4):780–785

    Article  Google Scholar 

  3. Nemes S, Gordon M, Rogmark C, Rolfson O (2014) Projections of total hip replacement in Sweden from 2013 to 2030. Acta Orthop 85(3):238–243

    Article  Google Scholar 

  4. Pilz V, Hanstein T, Skripitz R (2018) Projections of primary hip arthroplasty in Germany until 2040. Acta Orthop 89(3):308–313

    Article  Google Scholar 

  5. Losina E, Thornhill TS, Rome BN, Wright J, Katz JN (2012) The dramatic increase in total knee replacement utilization rates in the United States cannot be fully explained by growth in population size and the obesity epidemic. J Bone JtSurg Am 94(3):201–207

    Article  Google Scholar 

  6. Coleman D, Rowthorn R (2011) Who’s afraid of population decline? A critical examination of its consequences. Popul Dev Rev 37(Suppl 1):217–248

    Article  Google Scholar 

  7. Bozic KJ, Katz P, Cisternas M, Ono L, Ries MD, Showstack J (2005) Hospital resource utilization for primary and revision total hip arthroplasty. J Bone JtSurg Am 87(3):570–576

    Article  Google Scholar 

  8. Bozic KJ, Ries MD (2005) The impact of infection after total hip arthroplasty on hospital and surgeon resource utilization. J Bone JtSurg Am 87(8):1746–1751

    Google Scholar 

  9. Kurtz SM, Lau E, Watson H, Schmier JK, Parvizi J (2012) Economic burden of periprosthetic joint infection in the United States. J Arthroplasty 27(8 Suppl):61-65.e61

    Article  Google Scholar 

  10. Prokopetz JJ, Losina E, Bliss RL, Wright J, Baron JA, Katz JN (2012) Risk factors for revision of primary total hip arthroplasty: a systematic review. BMC MusculoskeletDisord 13:251

    Article  Google Scholar 

  11. Pulido L, Parvizi J, Macgibeny M et al (2008) In hospital complications after total joint arthroplasty. J Arthroplasty 23(6 Suppl 1):139–145

    Article  Google Scholar 

  12. Vanhegan IS, Malik AK, Jayakumar P, Ul Islam S, Haddad FS (2012) A financialanalysis of revision hip arthroplasty: the economicburden in relation to the national tariff. J BoneJtSurg (British volume) 94(5):619–623

    CAS  Google Scholar 

  13. Lubbeke A, Silman AJ, Barea C, Prieto-Alhambra D, Carr AJ (2018) Mapping existing hip and knee replacement registries in Europe. Health Policy (Amsterdam, Netherlands) 122(5):548–557

    Article  CAS  Google Scholar 

  14. Pötzsch ORF (2015) Demographic analyses, methods and projections, births and deaths: Germany’s population by. 2060. Results of the 13th coordinated population projection. Federal Statistical Office, Wiesbaden.

  15. Malchau H, Herberts P, Eisler T, Garellick G, Soderman P (2002) The Swedish total hip replacement register. J BoneJtSurg Am 84-A(Suppl 2):2–20

    Google Scholar 

  16. Petzold T, Haase E, Niethard FU, Schmitt J (2016) Orthopaedic and trauma surgical care until 2050. Analysis of the utilization behavior for relevant diseases and derivation of the number of medical service providers. Orthopade 45(2):167–173

    Article  CAS  Google Scholar 

  17. Culliford D, Maskell J, Judge A et al (2015) Future projections of total hip and knee arthroplasty in the UK: results from the UK Clinical Practice Research Datalink. Osteoarthr Cartilage 23(4):594–600

    Article  CAS  Google Scholar 

  18. Erivan R, Villatte G, Dartus J, Reina N, Descamps S, Boisgard S (2019) Progression and projection for hip surgery in France, 2008–2070: epidemiologic study with trend and projection analysis. OrthopTraumatolSurg Res 105(7):1227–1235

    Google Scholar 

  19. Leitner L, Turk S, Heidinger M et al (2018) Trends and economic impact of hip and knee arthroplasty in Central Europe: findings from the Austrian national database. Sci Rep 8(1):4707

    Article  Google Scholar 

  20. Musumeci A, Pranovi G, Masiero S (2018) Patient education and rehabilitation after hip arthroplasty in an Italian spa center: a pilot study on its feasibility. Int J Biometeorol 62(8):1489–1496

    Article  Google Scholar 

  21. Patel A, Pavlou G, Mujica-Mota RE, Toms AD (2015) The epidemiology of revision total knee and hip arthroplasty in England and Wales: a comparative analysis with projections for the United States. A study using the National Joint Registry dataset. Bone Jt J 97-b(8):1076–1081

    Article  CAS  Google Scholar 

  22. Paprosky WG, Sloan M, Sheth NP (2019) Trends in revision total hip arthroplasty, 1993–2014. Orthopaed Proc 101B((Supp_12)):33–33

    Google Scholar 

  23. Sabah SA, Henckel J, Koutsouris S et al (2016) Are all metal-on-metal hip revisionoperationscontributing to the National Joint Registry implant survivalcurves? : a studycomparing the London Implant Retrieval Centre and National Joint Registrydatasets. BoneJt J 98-B(1):33–39

    CAS  Google Scholar 

  24. Schmalzried TP (2012) The painful hip: diagnosis and deliverance. J Bone JtSurg (British volume) 94(11 Suppl A):55–57

    Article  CAS  Google Scholar 

  25. Devane PA, Horne JG, Ashmore A, Mutimer J, Kim W, Stanley J (2017) Highly cross-linked polyethylene reduces wear and revision rates in total hip arthroplasty: a 10-year double-blinded randomized controlled trial. J Bone JtSurg Am 99(20):1703–1714

    Article  Google Scholar 

Download references

Funding

There is no funding source.

Author information

Authors and Affiliations

  1. Department of Trauma and Orthopedic Surgery, BG Unfallklinik Frankfurt Am Main, Friedberger Landstraße 430, 60389, Frankfurt am Main, Germany

    Alexander Klug, Yves Gramlich & Reinhard Hoffmann

  2. Numerics Data, Mühlebachstr. 81, 8008, Zürich, Switzerland

    Dominik H. Pfluger

  3. Department of Orthopedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany

    Philipp Drees & Karl Philipp Kutzner

  4. Department of Orthopaedic Surgery and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany

    Karl Philipp Kutzner

Authors
  1. Alexander Klug
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dominik H. Pfluger
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yves Gramlich
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Reinhard Hoffmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Philipp Drees
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Karl Philipp Kutzner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alexander Klug.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest. None of the authors, their immediate families, nor any research foundation with which they are affiliated, received any financial payments or other benefits from any commercial entity related to the subject of this article.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Klug, A., Pfluger, D.H., Gramlich, Y. et al. Future burden of primary and revision hip arthroplasty in Germany: a socio-economic challenge. Arch Orthop Trauma Surg 141, 2001–2010 (2021). https://doi.org/10.1007/s00402-021-03884-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-021-03884-2

Keywords

Search

Navigation