[Utilization rates of lower extremity prostheses in Germany and Switzerland: A comparison of the years 2005-2008].

BACKGROUND: In the United States the use of total hip arthroplasty (THA) has substantially increased over the last decade. It is not known, however, if this trend can be applied to other countries as well. The aim of the current study was therefore a detailed comparison of hip, knee, and ankle arthroplasty utilization rates in Germany and Switzerland in the years 2005-2008 and a secondary comparison with the United States.

PATIENTS AND METHODS: Based on datasets from the national statistical offices the number of inhabitants, gender and age distributions and the number of primary and revision surgeries were determined. These figures served for calculating primary, revision and overall surgical volumes, revision burden, primary and revision rates per 100,000 inhabitants, gender and age-specific primary and revision rates. A comparably smaller dataset was provided for the respective US analyses.

RESULTS: In Germany, Switzerland and the US the number of implanted total and partial hip arthroplasties per 100,000 inhabitants rose from 235.8, 238.2 and 116.8 in 2005 to 254.7, 262.7 and 127.3 in 2008, respectively. For total and partial knee arthroplasty the rates were 156.3, 140.1 and 178.2 implantations in 2005 and 188.3, 176.8 and 213.6 in 2008, respectively. With 13.6% the revision burden in Germany was 3.6% higher than in Switzerland and accounted for 11.2% in the US. In 2008 it was 15.1% in Germany, was hence 4.6% higher than in Switzerland and remained stable at 11.2% in the US. For knee replacements the 2005 German revision burden was 11.1% which was 3.5% higher than in Switzerland and was 7.4% in the US. In 2008 it was 12.8% in Germany and 4.2% lower in Switzerland and in the US it accounted for 8.9%. In all three countries the revision burden for knee arthroplasty was constantly lower than for hip arthroplasty.

CONCLUSION: In all three countries the primary rates for hip and knee replacements rose over the years but those for knee arthroplasty to a higher extent. The 2008 revision burden was highest in Germany for both types of arthroplasty. In Switzerland there was a transient revision burden decrease with a new increase from the year 2007 onwards. The US hip replacement utilization rates per 100,000 inhabitants were considerably lower than those in Germany and Switzerland and for knee replacements they were slightly higher.