Total hip replacement surgery (THR) is an effective procedure for reducing pain and improving function in people with advanced hip osteoarthritis (OA), and a range of studies provide evidence of cost effectiveness. However, aging populations, projected growth in demand for THR and predicted health workforce shortages in orthopedic surgery all underscore the importance of using contemporary, population-level data to plan for future service provision.
In new research published in November 2017 Arthritis Care & Research, Ilana N. Ackerman, PhD, and colleagues from Monash University and the University of Melbourne, Australia, set out to address this issue and compare the lifetime risk of THR for OA between countries over time. Researchers used data from national arthroplasty registries from five countries (i.e., Australia, Denmark, Finland, Norway and Sweden) from 2003–2013. They also obtained life tables and population data for each country and examined the trends in age- and sex-specific utilization rates for primary THR.
“We found that the lifetime risk of THR increased significantly over time for males in all five countries and females in all five countries,” write the authors in their discussion. “The rise in lifetime risk could potentially reflect changes in clinical practice, as well as higher-level policy.”
Between 2003 and 2013, more than half the THR procedures in each country were performed on women. Most notably, the proportion of THRs performed on women was higher in Norway (70.5% in 2003 and 65.5% in 2013) than in the other four countries (54.5–58.1% in 2003 and 53.3–56.6% in 2013). Additionally, the data showed little change in the proportion of THR surgeries performed for people younger than age 60 in each country from 2003–2013. In each country in 2003 and 2013, the highest THR rate was among people—both men and women—aged 70–79 years old. Within the age range in 2013, women in Finland experienced the highest rate of THR surgeries, with 1,081 procedures per 100,000 people.
Lifetime risk: Women consistently had a higher lifetime risk of surgery in all five countries. In 2013, Demark had the lowest lifetime risk for women, and Norway had the greatest lifetime risk for women. (Note: Norway had the highest lifetime risk for women in 2003 (15.9%) and remained high in 2013 (16%). Women in Norway also had almost double the lifetime risk of surgery than men. Australia had the greatest absolute increase in lifetime risk for women (3.4%) over the 10-year period.
For men, all five countries demonstrated a significant increase in lifetime risk for THR over time, with Norway having the lowest lifetime risk in 2013 and Finland having the highest lifetime risk in 2013. Australia and Denmark had the greatest absolute increase (2.9% and 2.7%, respectively), while Norway had the lowest absolute increase (1.4%).
“These lifetime risk estimates can be used by individual countries to inform public health policy and for resource planning,” write the authors in their discussion. “These data allow us to better comprehend the changing burden of advanced hip OA and its surgical management at an international level, and can be used to inform the planning of health service delivery to meet growing population demand.”
Ackerman IN, Bohensky MA, de Steiger R, et al. Lifetime risk of primary total hip replacement surgery for osteoarthritis from 2003 to 2013: A multinational analysis using national registry data. Arthritis Care Res (Hoboken). 2017 Nov;69(11):1659–1667. doi: 10.1002/acr.23197. Epub 2017 Sep 26.