Worldwide Disparities in Total Hip and Knee Replacement Procedures

An international survey comparing the incidence of hip and knee arthroplasty shows vast differences in the countries that were reviewed across four continents.

Researchers at Porto University (Portugal) analyzed the age-standardized incidence rates (ASIR; statistically corrected results for age structure of the population that allows comparison between different areas) of total hip replacement in 31 countries and total knee replacement in 28 countries that keep comprehensive records. The ASIR results were correlated to possibly relevant socioeconomic and health data, such as overweight, obesity, coxarthrosis, and gonarthrosis, and other issues statistically associated with the geographical differences in joint replacement.

Country list leaders in hip arthroplasty were Austria (266.2 annually per 100,000 inhabitants), Luxembourg (226.0) and Switzerland (225.8). Topping the list in knee arthroplasty were the United States (221.5), Austria (183.6) and Switzerland (173.6). The laggards in hip arthroplasty turned out to be Brazil (11.3), Mexico (15.9), and South Korea (16.7). In knee arthroplasty, the lowest rates were found in Brazil (4.3), Romania (5.3) and Mexico (7.8). Very low rates in some Eastern Europe countries contrasted with middle range rates in countries such as Italy, Spain, or Finland, while very high rates were demonstrated in a cluster of countries in Central Western Europe, including Austria, Germany, Switzerland, France, Belgium, the Netherlands, and Luxembourg.

In a second step, the researchers analyzed potentially decisive parameters for higher or lower rates of joint arthroplasty; but among the variables analyzed, the researchers could not identify any health risk factors responsible for the huge disparities revealed, only economic ones. For example, patients living in countries with a higher gross domestic product (GDP), higher public investments in health systems, and a higher Human Development Index (HDI) had much better chances of obtaining arthroplasty than those in poorer countries, regardless of their needs. The study was presented at the 12th Congress of the European Federation of National Associations of Orthopaedics and Traumatology (EFORT), held during June 2011 in Copenhagen (Denmark).

"Studies show a steep increase in knee arthroplasty in many countries during the last 10 years; the rates have tripled, for example, in Switzerland, Italy and Spain," said study presenter Prof. Maria de Fátima de Pina, MD. "That was not due to so many more cases of osteoarthrosis, but rather to improved materials and insights in biomechanics that enabled surgeons to safely operate in many more cases than they were able to do a decade ago."

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