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Total hip arthroplasty demand rising on a global level
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NEW ORLEANS – The demand for total hip arthroplasty has grown substantially around the world, according to a study presented here.
The findings were presented by Steven M. Kurtz, PhD, at the 56th Annual Meeting of the Orthopaedic Research Society.
Kurtz said his team investigated international total hip arthroplasty (THA) rates because of the substantial increase in THA utilization in the United States and the lack of previous studies comparing the U.S. rate with rates abroad.
“We had received feedback that some of those growth trajectories might either be unrealistic or very high, so we were prompted to look at the utilization rates for joint replacement in other countries and how the United States compares,” he said.
Study methods and parameters
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The researchers queried nine national inpatient databases — one each from the United States, Spain, Portugal, The Netherlands, Canada, France, Italy, Switzerland and Germany. Inpatient data were also compared with published registry data for six countries with operating arthroplasty registers — Romania, Denmark, England and Wales, Sweden, Norway and Australia.
The team calculated the rate of hip arthroplasty annually as the number of procedures per 100,000 people in the population. The change in arthroplasty rate over time was estimated by linear regression with year as the independent variable. The “burden” of revision was defined as the fraction of revision surgeries among all primary and revision hip arthroplasties, as it could be used as a gauge of the relative frequency of revisions among different countries.
Pearson correlations were computed between rates of surgery and the proportion of elderly or female patients.
Significant increases
In all, the researchers found an estimated 959,000 annual primary and revision total hip procedures. The average rate of THA was 131 procedures per 100,000 population, and the average revision burden was found to be 12.9%. According to the findings, 57.7% of the patients were women and 32.9% of patients were under the age of 65 years.
The only clear correlation, the researchers found, was between the national population and the annual number of THA procedures performed per country. There were no significant correlations between patient factors and either the national rates of surgery or the national revision burden.
As for the United States and its increasing rate of THA utilization, Kurtz was surprised to find that it did not match rates put up by other countries in the study.
“I expected the United States to end up at the top of the list, but it actually ended below the international average in terms of number of procedures per population,” Kurtz said.
The team did find that — with the exception of France — the procedure rate significantly increased over time for the countries in which historical data were available. The compound annual growth of the THA utilization rate was 3.2% on average, with a large range (0.6% in France and 10.3% in Romania).
Unexplained variation
According to the study, the international variations in THA utilization rates do not appear to be explained by patient demographics. Furthermore, the data points toward the demand THA rising “substantially” over the past decade in countries outside of the United States.
The researchers did point out that it is not yet clear whether observed differences might be explained by national factors such as the type of health care system in place, access to care, number and distribution of orthopedic surgeons, and the prevalence of joint disease. — by Robert Press
Reference:
- Kurtz SM, Roder C, Lau E, et al. International survey of primary and revision total hip replacement. Paper #365. Presented at the 56th Annual Meeting of the Orthopaedic Research Society. March 6-9, 2010. New Orleans.
- Steven M. Kurtz, PhD, can be reached at skurtz@exponent.com.
