Objective: To report on health care utilization and associated cost for musculoskeletal conditions in Germany

Methods: As part of a Bone and Joint Decade project data were collected from governmental bodies, health insurance companies, pension funds, hospital discharge reports and other sources for the year 2002.

Results: According to the hospital discharge reports 17.8 % of all acute hospital days were due to musculoskeletal conditions or injuries, with joint disorders and back problems being the most frequent reasons for admission. 40% of all inpatient rehabilitation treatments were caused by musculoskeletal conditions. In the ambulatory segment, 27% of all patients visited during a 12 month period an orthopaedic surgeon or a rheuma-tologist. In addition, 37% of all GP consultations were due to musculoskeletal complains. These disorders were also responsible for about 40% of all days lost from work and 25% of all early retirements. The overall cost for musculoskeletal conditions in 1999 in Germany was about 40 Billion Euro, with back problems responsible for about 50%, and joint problems for another 30%.

Conclusion: Musculoskeletal conditions are the major cause of morbidity in the German society and substantially influence health and quality of life, with enormous cost to health systems. Considering the demographic changes immediate strategies have to be developed to address these problems, to prevent the diseases and to allow for early and appropriate care.

In order to assess current opinions on the long-term outcome after primary total hip replacement, we performed a multicentre, cross-sectional survey in 22 centres from 12 European countries. Different patient characteristics were categorised into ‘decreases chances’, ‘does not affect chances’, and ‘increases chances’ of a favourable long-term outcome, by 304 orthopaedic surgeons and 314 referring practitioners. The latter were less likely to associate age older than 80 years and obesity with a favourable outcome than orthopaedic surgeons (p < 0.001 and p = 0.006, respectively) and more likely to associate age younger than 50 years with a favourable outcome (p = 0.006). Comorbidity, rheumatoid arthritis, and poor bone quality were thought to be associated with a decreased chance of a favourable outcome. We found important differences in the opinions regarding long-term outcome after total hip replacement within and between referring practitioners and orthopaedic surgeons. These are likely to affect access to and the provision of total hip replacement.

Aims: The purpose of this presentation is to discuss what population interventions are effective, what the evidence for the different interventions for the different conditions is and how one can identify those who will benefit most. Methods: Evidence of effective interventions for primary, secondary and tertiary prevention of the individual conditions has been identified from systematic reviews and guidelines through literature review. From this and expert opinion, recommendations have been developed which follow a template to enable common themes appropriate to the different musculo-skeletal conditions to emerge. Results: Common factors with an effect on the population level on different musculoskeletal conditions include exercise, body weight, diet, smoking, alcohol and occupational factors. One specific factor is injury prevention including falls to prevent osteoporotic fractures. One recommendation supported by evidence that applies to all conditions considered is the need for early appropriate intervention for those at highest risk or with early features of the condition. Evidence for the different interventions for the conditions will be presented Conclusions: Prevention of musculoskeletal conditions on a population level is possible. If risk factors for the different conditions are identified, development of effective interventions is necessary.

Aims: The purpose of this presentation is to discuss what population interventions are effective, what the evidence for the different interventions for the different conditions is and how one can identify those who will benefit most. Methods: Evidence of effective interventions for primary, secondary and tertiary prevention of the individual conditions has been identified from systematic reviews and guidelines through literature review. From this and expert opinion, recommendations have been developed which follow a template to enable common themes appropriate to the different musculoskeletal conditions to emerge. Results: Common factors with an effect on the population level on different musculoskeletal conditions include exercise, body weight, diet, smoking, alcohol and occupational factors. One specific factor is injury prevention including falls to prevent osteoporotic fractures. One recommendation supported by evidence that applies to all conditions considered is the need for early appropriate intervention for those at highest risk or with early features of the condition. Evidence for the different interventions for the conditions will be presented Conclusions: Prevention of musculoskeletal conditions on a population level is possible. If risk factors for the different conditions are identified, development of effective interventions is necessary.