INTRODUCTION: Total hip and knee replacement (THA and TKA) are successful operations based on patient-reported outcomes and short-term socioeconomic evaluations. However, other data have shown problems regarding persistent pain and function. No detailed large-scale, long-term socioeconomic data exist on income and total health expenses before and after THA and TKA compared with a matched reference population (RP).

METHODS: From the unique nationwide Danish registers, a total of 128,109 patients undergoing primary THA and TKA were followed from up to 12 years before to up to 12 years after surgery. The economic analysis of the total costs before and after surgery were divided into annual healthcare costs (outpatient services, inpatient admissions, prescription drugs and physician office visits), home care and loss of income and compared with a matched RP.

RESULTS: Healthcare costs increased by about 10,000 € in the year of surgery followed by an increase of about 6,000 €/yr/patient in both operations due to a loss of employment income, a need for home care and the use of medications, also compared with an RP. Survival was slightly better for patients than for the RP, suggesting that severe co-morbidities have only a limited role in explaining the increased costs.

CONCLUSIONS: The healthcare costs and income of patients undergoing THA and TKA are comparable to those of their matched RP until three years before the operation, but TKA and THA patients continuously have higher healthcare costs and lower income levels than the RP after surgery. These data should be taken into account in future studies of patient expectations and strategies for enhanced rehabilitation.

FUNDING: none.

TRIAL REGISTRATION: none.