# Total hip arthroplasty in Italy: an observational, population-based study on surgical volume growth from 2001 to 2023 and forecasts until 2050 with six different statistical models

## TL;DR

This study analyzed the growth of hip replacement surgeries in Italy from 2001 to 2023 and predicts future trends up to 2050 to help plan healthcare resources.

## Contribution

The study introduces a comparative analysis of six statistical models to forecast hip surgery demand in Italy, with a focus on healthcare planning.

## Key findings

- Hip replacement surgeries in Italy increased by 80% from 2001 to 2023.
- The hierarchical Poisson regression model with temporal effects showed the best forecasting performance.
- THA volumes are projected to rise by 10–40% by 2050, peaking in 2036.

## Abstract

The number of total hip arthroplasty (THA) procedures has been steadily increasing worldwide, driven by aging population, improvements in surgical techniques and implant design. This study aimed to analyze the temporal trends of elective THA in Italy since 2001–2023 and forecast THA volumes up to 2050 to provide insights for healthcare planning.

International Classification of Diseases, 9th Revision, Clinical Modification (ICD9-CM) coding system was used to extract records of interest (elective THA) from the Italian National Hospital Discharge Record database. Six statistical models were applied to forecast future THA volumes: logistic regression; Poisson regression; logarithmic regression; inverse/power regression; Poisson log-normal regression; and hierarchical Poisson regression with temporal effects (HPTE). Model performances were assessed by using error metrics and internal validation on the basis of a rolling-origin approach. An out-of-sample validation was conducted to ensure a robust assessment of forecasting reliability. THA volume forecasts were provided with 95% prediction intervals.

A total of 1,318,400 records for primary elective THAs performed in Italy since 2001–2023 were analyzed. The number of THAs increased by approximately 80%, rising from 68.270 in 2001 to 122.777 in 2023. Among the tested models, HPTE generally showed the best fitting and forecasting performances. By using the HPTE model, the forecasts showed an increase in THA volumes up to a maximum rate ratio (RR) of 1.3 (PI95%: 1.1–1.4) in terms of RR in 2036, then decreasing to a RR equal to 1.2 (PI95%: 1.1–1.4) by 2050 with respect to 2019.

Our findings forecast a steady increase between 10% and 40% in THA, driven by demographic and epidemiological trends. These projections are essential for anticipating future surgical demand and guiding healthcare system planning. Without adequate investment and strategic planning, rising volumes may strain service capacity and sustainability.

Level of evidence: population based study, level 1 evidence.

The online version contains supplementary material available at 10.1186/s10195-025-00893-4.