Diverging trends in primary and revision arthroplasty in Germany: projections and implications for healthcare delivery for the next ten years

To analyze nationwide trends, demographic changes, and future projections of primary and revision hip and knee arthroplasty in Germany.

Nationwide data from the German Federal Statistical Office and hospital quality reports (2015–2024) were analyzed regarding procedure volumes, age distribution, hospital stay, and structural care changes. Future case numbers until 2035 were projected using age-specific incidence rates and population forecasts.

Primary hip and knee arthroplasty volumes increased significantly, with annual growth rates of + 4,986 cases for hip (p = 0.005) and + 5,727 cases for knee arthroplasty (p = 0.028), whereas revision procedures remained stable (hip: p = 0.065; knee: p = 0.947). Age-stratified analyses demonstrated a shift toward older patients, with increasing proportions in age groups ≥ 60 years and declining shares among patients ≤ 50 years. Projections to 2035 indicate stable overall primary procedure numbers (+ 637 cases), with an increase in hip arthroplasty (+ 11,202 cases) and a decrease in knee arthroplasty (− 10,565 cases), while revision procedures are expected to rise by + 3,158 cases, particularly in patients > 75 years. Length of hospital stay decreased significantly across all procedures (− 0.38 to − 0.46 days per year; p < 0.001), and the number of hospitals declined markedly between 2019 and 2024 (− 19.2 to − 25.6 hospitals per year), reflecting increasing centralization of primary care, whereas revision procedures remained widely distributed, also across low-volume centers.

These findings reveal a growing mismatch between increasing demand, demographic changes, and current care structures, underscoring the need for targeted adaptations in arthroplasty care delivery.