Hip and Knee Replacement

9. HEALTH CARE ACTIVITIES Hip and knee replacement

Hip and knee replacements are some of the most frequently obesity rates in OECD countries. For example, in the United performed and effective surgeries worldwide. The main States, the prevalence of knee osteoarthritis has more than indication for hip and knee replacement (joint replacement doubled since the mid-20th century (Wallace et al., 2017[4]). surgery) is osteoarthritis, which leads to reduced function Most OECD countries show increasing trends of varying and quality of life. degrees, but Ireland and Luxembourg show slower growth Osteoarthritis is a degenerative form of arthritis than the average, these are also the only OECD countries to characterised by the wearing down of cartilage that show a decrease in hip replacements rates from 2007. cushions and smooths the movement of joints – most commonly for the hip and knee. It causes pain, swelling and stiffness resulting in a loss of mobility and function. Definition and comparability Osteoarthritis is one of the ten most disabling diseases in developed countries. Worldwide, estimates show that 10% Hip replacement is a surgical procedure in which the of men and 18% of women aged over 60 years have hip joint is replaced by a prosthetic implant. It is symptomatic osteoarthritis, including moderate and severe generally conducted to relieve arthritis pain or treat forms (WHO, 2014[1]). severe physical joint damage following hip fracture. Age is the strongest predictor of the development and Knee replacement is a surgical procedure to replace progression of osteoarthritis. It is more common in women, the weight-bearing surfaces of the knee joint in order increasing after the age of 50 especially in the hand and to relieve the pain and disability of osteoarthritis. It knee. Other risk factors include obesity, physical inactivity, may also be performed for other knee diseases such as smoking, excessive alcohol consumption and injuries. rheumatoid arthritis. While joint replacement surgery is mainly carried out Classification systems and registration practices vary among people aged 60 and over, it can also be performed on across countries, which may affect the comparability people at younger ages. of the data. While most countries include both total In 2017, Germany, Austria, Switzerland, Finland, and partial hip replacement, some countries only Luxembourg and Belgium were among the countries with include total replacement. In Ireland, Mexico, New the highest rates for hip and knee replacement (Figure 9.12 Zealand and the United Kingdom, the data only and Figure 9.13). The OECD averages are 182 per 100 000 include activities in publicly funded hospitals, thereby population for hip replacement, and 135 per 100 000 for knee underestimating the number of total procedures replacement. Mexico, Portugal, Israel, Ireland and Korea presented here (for example, approximately 15% of all have low hip and knee replacement rates. Differences in hospital activity in Ireland is undertaken in private population structure may explain part of this variation hospitals). Data for Portugal relate only to public across countries, and age standardisation reduces it to some hospitals on the mainland. Data for Spain only partly extent. Nevertheless, large differences persist and the include activities in private hospitals. country ranking does not change significantly after age standardisation (McPherson, Gon and Scott, 2013[2]). National averages can mask important variation in hip and knee replacement rates within countries. In Australia, References Canada, Germany, France and Italy, the rate of knee [2] McPherson, K., G. Gon and M. Scott (2013), “International replacement is more than twice as high in some regions Variations in a Selected Number of Surgical Procedures”, than others, even after age-standardisation (OECD, 2014[3]). OECD Health Working Papers, No. 61, OECD Publishing, Paris, Alongside the number of operations, the quality of hip and https://dx.doi.org/10.1787/5k49h4p5g9mw-en. knee surgery (see indicator on “Hip and knee surgery” in [3] OECD (2014), Geographic Variations in Health Care: What Do We Chapter 6) and waiting times (see indicator on “Waiting Know and What Can Be Done to Improve Health System times for elective surgery” in Chapter 5) are also critical for Performance?, OECD Health Policy Studies, OECD Publishing, patients. Paris, https://dx.doi.org/10.1787/9789264216594-en. Since 2000, the number of hip and knee replacements has [4] Wallace, I. et al. (2017), “Knee osteoarthritis has doubled in increased rapidly in most OECD countries (Figure 9.14 and prevalence since the mid-20th century”, Proceedings of the Figure 9.15). On average, hip replacement rates increased by National Academy of Sciences, Vol. 114/35, pp. 9332-9336, http:// 30% between 2007 and 2017 and knee replacement rates by dx.doi.org/10.1073/pnas.1703856114. 40%. This aligns with the rising incidence and prevalence of [1] WHO (2014), “Chronic Rheumatic Conditions”, Fact Sheet, osteoarthritis, caused by ageing populations and growing http://www.who.int/chp/topics/rheumatic/en/.

198 HEALTH AT A GLANCE 2019 © OECD 2019 9. HEALTH CARE ACTIVITIES

Hip and knee replacement

Figure 9.12. Hip replacement surgery, 2017 (or nearest year) Figure 9.13. Knee replacement surgery, 2017 (or nearest year)

Germany 309 Switzerland 307 Switzerland 251 Austria 286 Austria 227 Belgium 274 Luxembourg 226 Finland 271 Finland 224 Norway 252 Germany 223 France 248 Australia 213 Denmark 248 Belgium 210 Sweden 240 Canada 191 Netherlands 238 France 175 Iceland 224 Denmark 163 Slovenia 200 Netherlands 159 Australia 195 United Kingdom 145 Luxembourg 194 Korea 136 Lithuania 194 OECD31 135 Czech Republic 189 Czech Republic 132 Italy 183 Sweden 132 OECD32 182 Lithuania 130 United Kingdom 181 Spain 130 Poland 160 Slovenia 128 Canada 159 Norway 126 New Zealand 158 Italy 124 Latvia 157 New Zealand 111 Estonia 156 Slovak Republic 106 Hungary 139 Latvia 103 Slovak Republic 136 Hungary 85 Ireland 130 Estonia 82 Spain 116 Israel 66 Portugal 91 Poland 64 Israel 67 Portugal 62 Korea 56 Ireland 49 Chile 46 Mexico 9 Chile 19 Mexico 4 0 50 100 150 200 250 300 350 0 50 100 150 200 250 300 Per 100 000 population Per 100 000 population

Source: OECD Health Statistics 2019. Source: OECD Health Statistics 2019. StatLink 2 https://doi.org/10.1787/888934017842 StatLink 2 https://doi.org/10.1787/888934017861

Figure 9.14. Hip replacement surgery trends in selected Figure 9.15. Knee replacement surgery trends in selected OECD countries, 2007-17 OECD countries, 2007-17

Canada Germany Italy Belgium France Hungary Sweden OECD30 Slovenia OECD29 Per 100 000 population Per 100 000 population 350 250

300 200

250 150

200 100

150 50

100 0 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Source: OECD Health Statistics 2019. Source: OECD Health Statistics 2019. StatLink 2 https://doi.org/10.1787/888934017880 StatLink 2 https://doi.org/10.1787/888934017899

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Please cite this chapter as:

OECD (2019), “Hip and knee replacement”, in Health at a Glance 2019: OECD Indicators, OECD Publishing, Paris.

DOI: https://doi.org/10.1787/2fc83b9a-en

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