so extrapolation of the data must be performed to come up with national
estimates.
The first FDA-approved total hip replacement in the United States was
performed by Dr. Mark Coventry at the Mayo Clinic on March 10, 1969.
John Charnley had been performing “modern” total hip replacements for
almost a decade when Coventry officially implanted the first hip in
America. FDA approval for medical devices would become much more
stringent after the Dalkon Shield fiasco in 1976, and the Medical Device
Amendments of 1976 (to the Food, Drug, and Cosmetic Act of 1938)
greatly strengthened the federal government’s oversight of devices.
At the passage of the 1965 Medicare Act, there had been no total hip
replacements performed in the United States. Because the AHRQ was only
established in 1989, there is scant evidence about the volume of hip
arthroplasty volumes prior to the 1990s. In the Mayo Database (formed in
1969 with the insertion of the first hip), there is precise information about
joint replacement volume at the Mayo Clinic. At one of the world’s busiest
joint replacement hospitals there was a total of 35,167 hip replacement
operations from 1969 to 2000.^5 Even though that number started slowly
and ballooned, it only represents a little over one thousand hips per year.
What has happened over the last few decades, then, is remarkable.
From the AHRQ’s NIS, there were 290,700 hip replacements in 1997 in
America. By the year 2000, there were over 300,000 hips replaced in
America; in 2005 there were 383,500. In 2007, in the JBJS, an
investigation on the numbers of hip and knee replacements was conducted,
and based upon the volumes and the changing demographics of America
(i.e., the aging of the Baby Boomers), the authors predicted that by 2020
there would be 384,000 primary totals hip replacements and 67,600
revision hip operations.^6 That number swells to 572,000 primary and
96,700 revision hip replacements per year by 2030. Those 2030
predictions represent a 137 percent increase over 2005. The striking
observation in reading that 2007 article now is the degree to which the
2014 data blows away the predictions.
A December 2017 Statistical Brief by the AHRQ entitled, “Overview of
Operating Room Procedures During Inpatient Stays in U.S. Hospitals,
2014” reports that in 2014 there were 522,800 hip replacement operations
(not counting the nearly 300,000 operations for hip fractures, which are
often treated with partial or total hip replacements).^7 Therefore, in 2014,