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Cross-sectional analysis of association between socioeconomic status and utilization of primary total hip joint replacements 2006–7: Australian Orthopaedic Association National Joint Replacement Registry

Sharon L Brennan12*, Tyman Stanford3, Anita E Wluka4, Margaret J Henry1, Richard S Page5, Stephen E Graves6, Mark A Kotowicz7, Geoffrey C Nicholson8 and Julie A Pasco12

Author Affiliations

1 Barwon Epidemiology and Biostatistics Unit, Barwon Health, Deakin University, Kitchener House, PO Box 281, Geelong, Victoria, 3220, Australia

2 North West Academic Centre, Department of Medicine, The University of Melbourne Western Health, 176 Furlong Rd, St Albans, VIC, 3021, Australia

3 Data Management and Analysis Centre, Discipline of Public Health, University of Adelaide, MDP DX650, Adelaide, SA, 5005, Australia

4 Department of Epidemiology and Preventive Medicine, Monash University, Alfred Centre, 89 Commercial Road, Melbourne, VIC, 3004, Australia

5 Barwon Orthopaedic Research Unit, Barwon Health, Ryrie Street, Geelong, VIC, 3220, Australia

6 Australian Orthopaedic Association Joint Replacement Registry, MDP DX650, Adelaide, SA, 5005, Australia

7 Department of Endocrinology and Diabetes, Barwon Health, Ryrie Street, Geelong, VIC, 3220, Australia

8 Rural Clinical School, The University of Queensland, Locked Bag 9009, Toowoomba, DC QLD, 4350, Australia

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BMC Musculoskeletal Disorders 2012, 13:63  doi:10.1186/1471-2474-13-63

Published: 30 April 2012



The utilization of total hip replacement (THR) surgery is rapidly increasing, however few data examine whether these procedures are associated with socioeconomic status (SES) within Australia. This study examined primary THR across SES for both genders for the Barwon Statistical Division (BSD) of Victoria, Australia.


Using the Australian Orthopaedic Association National Joint Replacement Registry data for 2006–7, primary THR with a diagnosis of osteoarthritis (OA) among residents of the BSD was ascertained. The Index of Relative Socioeconomic Disadvantage was used to measure SES; determined by matching residential addresses with Australian Bureau of Statistics census data. The data were categorised into quintiles; quintile 1 indicating the most disadvantaged. Age- and sex-specific rates of primary THR per 1,000 person years were reported for 10-year age bands using the total population at risk.


Females accounted for 46.9% of the 642 primary THR performed during 2006–7. THR utilization per 1,000 person years was 1.9 for males and 1.5 for females. The highest utilization of primary THR was observed in those aged 70–79 years (males 6.1, and females 5.4 per 1,000 person years). Overall, the U-shaped pattern of THR across SES gave the appearance of bimodality for both males and females, whereby rates were greater for both the most disadvantaged and least disadvantaged groups.


Further work on a larger scale is required to determine whether relationships between SES and THR utilization for the diagnosis of OA is attributable to lifestyle factors related to SES, or alternatively reflects geographic and health system biases. Identifying contributing factors associated with SES may enhance resource planning and enable more effective and focussed preventive strategies for hip OA.

Hip joint replacement; Socioeconomic status; Utilization; Australia