Trends and Regional Variation in Hip, Knee and Shoulder Replacement

The rate of hip, knee, and shoulder replacements for Medicare patients is growing rapidly, and there is widespread variation in how likely patients are to undergo this surgery, depending on where they live and their race, according to a new report from the Dartmouth Atlas Project.

This new analysis of Medicare data found a 15 percent increase in the overall rate of hip replacement, a 48 percent increase in the overall rate of knee replacement and a 67 percent increase in the overall rate of shoulder replacement from 2000-2001 to 2005-2006. Meanwhile, the rate of shoulder replacement was 10 times higher in some regions than others during 2005-2006, and the rates of hip and knee replacements were four times higher.

Researchers said the patterns suggest both overuse and underuse of these procedures. Some patients who could benefit from joint replacement may not be offered the procedure, while others may be receiving a procedure that they might choose to forego if they had received balanced information on risks and benefits.