Projections of primary hip arthroplasty in Germany until 2040

Background and purpose - The number of hip replacements in Germany has increased considerably during the last 2 decades but lately levelled off with no significant increase in operation rates. We analyzed the future trend of hip arthroplasty and projected the number of primary hip replacements that will be performed in Germany until 2040. Patients and methods - We used prevalence data of hip arthroplasty patients from 2010 to 2016 from the nationwide inpatient statistics and population forecasts from the German Federal Bureau of Statistics up to the year 2040. We used Poisson regression to estimate the expected annual number of arthroplasty surgeries with calendar year and patient age as covariates to account for differences among age groups and changes over time. Results - The number of primary hip replacements performed in Germany in 2040 was estimated to grow by 27% to 288 x 10³ (95% CI 250 x 10³-332 x 10³) from 2010. Projected counts were highest for patients aged 60 to 70 years. The estimated incidence rate was projected to 360 (95% CI 312-414) per 100,000 residents. However, incidence rates for individual age classes were found to be constant with a slight decrease over time for individual age classes. Interpretation - Our findings suggest a growth in the total hip arthroplasty count whereas incidence rate remained constant over age classes. We consider the future demographic change to an older population as well as the increasing life expectancy to be the main reasons for the increasing patient numbers rather than a general increase in the operation frequency.