How much does a hip operation cost? And why does it matter?

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A new hip at 112 Years. That happened to Gladys Hooper, who also sets a new world record as the oldest person to undergo a hip operation. How did it come to that? "I fell" Gladys reports and she is not alone with her problem. 90% of hip fractures are caused due to falls.

From E880 to E888. These are codes that are listed in the International Classification of Disease (IC9) and refer to a wide range of falls. Falls are commonly defined as “inadvertently coming to rest on the ground, floor or other lower level, excluding intentional change in position to rest in furniture, wall or other objects”. Health Care professionals generally tend to describe falls as events leading to injuries and ill health.1 Gladys Hooper also "came to rest on the ground". How would she describe a fall? Most probably as hurtful and sideways. Yes, sideways. Sideways falls are the most prominent cause of hip injuries in older adults.2

The world is changing too

Chances are high that the older get the more frail we get. Statistics don't give us any reasons to doubt that. Approximately 28-35% of people aged of 65 and over fall each year increasing to 32-42% for those over 70 years of age. The frequency of falls increases with age and frailty level. But the trend is clear. Age is one of the key risk factors for falls. Falls are the second leading cause of accidental or unintentional injury deaths worldwide. Each year an estimated 646 000 individuals die from falls globally and Adults older than 65 years of age suffer the greatest number of fatal falls.3 And that's not everything. Worldwide, the number of persons over 60 years is growing faster than any other age group. By 2050 the population of older people will be much larger than that of of children under the age of 14 years.

Illustration WHO Population development
UN World Population Prospects. 2017 Revision.

The economic imperative

Gladys Hooper's hip operations has cost around €5700. This is the average direct cost of a hip replacement in the United Kingdom. As a Dutch Citizen your new hip will be the most expensive one with around €8739.4 Hip or no hip; As a Western European you will pay more for your health than as a Eastern European. Maybe that has something to do with the population pyramide? Western European countries tend to have an older population. In health expenditure the United Kingdom lies somewhere above the average with €5000 per year. That's about one hip replacement for every citizen per year.

Statistics Health Care costs EU
OECD: Health Expenditure per Capita and as a Share of GDP. Health at a Glance: Europe 2018.

An impact on the ground also comes with an economic impact. Costs of falls in older age are significantly increasing all over the world. Fall-incurred costs are categorized into two aspects: Direct costs and indirect costs. A hip replacement causes direct health care costs of average of €5043 in the EU and involves the operation, medication and other adequate services like rehabilitation. Indirect costs are societal productivity losses of activities in which individuals or family care givers would have involved if he/she had not sustained fall-related injuries e.g. lost income.

A comprehensive study in the Netherlands estimated the costs per case spent on fall-related injuries in patients ≥65 years. Fractures led to 80% of the fall-related healthcare costs. The mean costs per fall were €9370. That equals a little less than two hip replacements. Persons ≥80 years accounted for 47% of all fall-related emergency department visits, and 66% of total costs of €675.4 million annually. 5

Be young forever

Even though there are underlying biological factors, the aging process is very individual. Falls occur with age and are associated with a decline of functional abilities.  However the decline is largely determined by factors related to lifestyle behaviour. Regular participation in moderate physical activity is integral to good health and maintaining independence, contributing to lowering risk of falls and fall-related injuries.6 We can't trick time but we can trick our bodies to stay young as long as possible. However, for Gladys Hooper, that is not possible anymore. Her son Derek Hermiston (85) reported that she died at the age 113, one year after her hip operation.

  1. Zecevic AA et al. (2006). Defining a fall and reasons for falling: Comparisons among the views of seniors, health care providers, and the research literature. The Gerontologist, 46:367- 376.
  2. Parkkari, Jari et al. (1999). Majority of Hip Fractures Occur as a Result of a Fall and Impact on the Greater Trochanter of the Femur. Calcified tissue international. 65. 183-7.
  3. Stevens JA et al. (2007). Fatalities and Injuries From Falls Among Older Adults, United States, 1993-2003 and 2001-2005. Journal of the American Medical Association, 297(1):32- 33.
  4. Stargardt, Tom. (2008). Health service costs in Europe: Cost and reimbursement of primary hip replacement in nine countries. Health economics. 17. S9-20.
  5. Hartholt, A. Klaas et. al. (2007-2009). Costs of falls in an ageing population: A nationwide study from the Netherlands
  6. Gardner MM, Robertson MG, Campbell AJ (2000). Exercise in preventing falls and fall related injuries in older people: A review of randomised controlled trials. British Journal of Sports Medicine, 34:7-17.