• P Garcia, C Domnick, G Lodde, and M J Raschke.
• Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Waldeyer Straße 1, 48149, Münster, Deutschland.
• Unfallchirurg. 2018 Jan 1; 121 (1): 20-29.

BackgroundSince 2005, when the Diagnosis-Related Group (DRG) system was introduced, an increasing number of surgical procedures have been reported in Germany. In particular, the numbers of elective arthroplasty and spinal surgery procedures have been controversial.ObjectivesThe focus of this study was analyzing the development of spinal surgery, arthroplasty, and fracture management.Materials And MethodsWe analyzed the database for all musculoskeletal operating procedure codes (OPS codes 5‑78 to 5‑86) from 2005 to 2013 collected by the German Federal Statistical Office.ResultsWith an increase in total patient numbers of 12.8%, there was a rise in in-patient musculoskeletal procedures of 43.5%; the highest increase in procedures was found in spinal surgery (130%). Despite an ageing population, the numbers of hip- and knee arthroplasty procedures initially decreased after 2011 and after 2009 respectively. The number of osteosyntheses showed a slight increase (16%), whereas the number of (elective) implant removals declined (-7%). An increase in novel techniques was noticeable, such as locked plate osteosynthesis (251%), shoulder arthroplasty (402%) or the use of bone substitutes in spinal surgery (+2,011%).ConclusionsDespite generally increasing volume growth, the numbers of hip and knee arthroplasty cases decreased. In addition to an ageing population and potential economic incentives, technical innovations and new implant systems should be considered when discussing increasing case numbers.

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