The most common condition for which total hip arthroplasty is done is severe OA of the hip [19]. In 2011, the National Center for Health Statistics reported that of the 230,144 total hip replacements surveyed, 85.5 % were due to OA [20]. The primary indication for this procedure is severe pain and related restriction in activities of daily living [19]. To relieve discomfort and increase function of severe symptomatic OA, a hip replacement is an effective and in some cases, an only option. Between 1990 and 2002 the rate of primary total hip arthroplasties per 100,000 persons increased by approximately 50 % [21]. In 2006, total hip replacements, including revision procedures, accounted for 37.6 % of nearly one million inpatient arthroplasty procedures performed [20].

Total hip arthroplasties have been performed in an aging population with end-stage-hip OA. In 2010, Singh et al. reported a correlation between increasing age and increasing incidence of total hip arthroplasty over time [22]. In their population-based study of trends using hip arthroplasty between 1969 and 2008, they found that ages 0- through 49, 50- through 59, and 60- through 69-year age groups, the rate of total hip replacement usage gradually increased. They also reported peaks of utilization in 2005–2008, increasing more than sevenfold, and almost doubling between 1997–2000 and 2005–2008 [22].

Partial hip replacement, generally a hemiarthroplasty in which the femoral head but not in the acetabulum is replaced, is performed principally for hip fracture (76 % of cases) [20]. Women have been reported to have higher incidence of fractures due to a greater prevalence of osteoporosis [20]. In 2006, the number of partial hip replacement procedures was estimated to be about 138,000 and 73 % of partial hip replacements were performed on females [20].

Revision total hip replacement consumes a disproportionate amount of cost and other resources and involves more morbidity than primary total hip replacement. Using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database of 51,345 revision total hip arthroplasty procedures performed between October 1, 2005, and December 31, 2006, Bozic et al. found that a greater number of revision total hip arthroplasty procedures were performed on females compared to their male counterparts; 29,252, and 21,979, respectively (n = 51,231) [23]. They also discovered that 10,370 (20.2 %) patients in whom revisions were done were <55 years old, while the highest number of revisions, totaling 13,858 (27.0 %), were patients 75–84 years old. The oldest age group, 85–99 years old, constituted only 4423 or 8.6 % of revisions (n = 51,315) [23]. Similarly, Dorey et al. found that younger patients, especially those who are active and place a greater demand on their hip replacements, require greater numbers of revision surgeries compared to older patients [24]. Geographically, the South (Delaware, District of Columbia, Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia, West Virginia, Alabama, Kentucky, Mississippi, Tennessee, Arkansas, Louisiana, Oklahoma, and Texas) had the highest revision rates 18,867 (36.7 %), compared to the Northeast (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont, New Jersey, New York, and Pennsylvania), 8729 (17.0 %) (n = 51,345) [23]. The correlation between southern geographic location and higher revision rates could be due to profession, surgeon accessibility, and cost.