Prevalence of total hip replacement: How much demand has been met?

Objective - To determine the prevalence of completed elective total hip replacements in a defined elderly population. Design - Cross sectional postal questionnaire survey with additional data and validation from general practice and hospital records. Setting - Six general practices in the English counties of Avon, Somerset, and Oxfordshire. Subjects - A total of 7806 patients aged 65 years and over (94.7% response). Results - The overall prevalence (95% confidence intervals) of elective total hip replacement was 5.3 (4.8, 5.8)%. Age and sex specific prevalences were 2.7 (2.0, 3.5)% in men and 4.1 (3.3, 4.9)% in women aged 65-74 years, and 5.2 (4.0, 6.5)% in men and 8.8 (7.6, 10.0)% in women aged 75 years and over. Of the 415 patients who had received elective total hip replacement, 28.2% had required bilateral surgery, 20% had received at least one operation privately, and 13% had required revision surgery. Conclusion - Our results show an increased level of satisfied demand for total hip replacement in elderly people compared with earlier estimates. The increasing prevalence of hip replacement is an indicator of increasing potential demand for revision procedures. Population based surveys are required to establish the level of unmet demand for primary procedures. Differences in past surgical activity may be important in interpreting the wide variation in current surgical rates.