Hip and knee replacements are amongst the most frequent elective (non-urgent) surgical procedures in the EU. In 2022, nearly 1 million hip replacements were performed across EU countries (up by about 20% since 2012), and 680 000 knee replacements (up by 30% since 2012). The main indication for hip and knee replacement is osteoarthritis, which leads to reduced function and quality of life and is one of the main contributors to years lived with disability among musculoskeletal conditions (WHO, 2024[1]). Before the pandemic, hip and knee replacement rates were steadily growing, driven by increases in osteoarthritis and other types of arthritis caused by ageing populations and growing obesity rates.
In 2022, 202 hip replacements per 100 000 population and 134 knee replacements per 100 000 population were performed across EU countries on average (Figure 7.24 and Figure 7.25). Germany, Austria and Denmark had the highest rates of hip and knee replacements among EU countries. Together with Belgium, these countries had hip replacement rates at least 40% higher than the EU average in 2022, while these three countries and Finland had knee replacements at least 50% higher. Outside the EU, Switzerland had even higher rates of hip and particularly knee replacements. Differences in the population structure and the share of older populations explain part of the variation across countries, but earlier OECD work has shown that large differences persist even after age standardisation and the country ranking does not change significantly (McPherson, Gon and Scott, 2013[2]).
During the first year of the pandemic in 2020, the volume of hip and knee replacements fell sharply in most EU countries as elective surgery was suspended for many weeks to free up resources to deal with COVID‑19 patients and avoid people being infected while seeking care. The total volume of hip and knee replacements fell by more than 25% in 2020 compared to 2019 in countries such as Malta, Hungary, Romania, Lithuania and Belgium. Outside the EU, the drop was even larger in the United Kingdom (56% for the total of hip and knee replacements) (Figure 7.24 and Figure 7.25). In 2021, almost two‑thirds of EU countries continued to have lower volumes of hip replacement and almost all EU countries still had lower levels of knee replacement than before the pandemic. These reductions in the volume of orthopaedic procedures during the first two years of the pandemic generated a backlog of patients waiting for treatment and an increase in waiting times in several countries (see indicator “Waiting times for elective surgery”).
In 2022, hip and knee replacement volumes rebounded in many countries, returning at least to their pre‑pandemic levels. On average across EU countries, the hip replacement rate was 7% higher in 2022 than in 2019, while the knee replacement was about the same in 2022 as in 2019. However, to address the backlog generated during the pandemic, it may not have been sufficient to simply return to pre‑pandemic activity levels. Countries such as Bulgaria, Lithuania, Croatia, Romania and Portugal had hip replacement volumes at least 10% higher in 2022 compared to 2019, being on a good trajectory to address the pandemic backlogs (without making prejudice to the overall existing waiting times in the country).
Czechia and Estonia were the only countries where hip replacements did not reduce during the pandemic. In 2022, Czechia performed about 50% more hip replacements and knee replacements compared to before the pandemic in 2019. This significant increase in orthopaedic surgery was due to lifting reimbursement limits for providers of these treatments as part of a wider reimbursement reform to avoid lengthening waiting times, which were reportedly long already before the pandemic. Czechia is now among the EU countries with the higher volume of orthopaedic surgery.
Many countries have taken actions to reduce backlogs of elective surgery created during the pandemic by providing additional funding to boost supply and/or contracting private providers in countries where public and private systems co‑exist (OECD/European Union, 2022[3]).
