OBJECTIVES: Worldwide the numbers of first use – implantations and revisions in the hip - and knee arthroplasty are rising. In many countries corresponding arthroplasty - registers have been introduced in order to increase the quality of such operations. Arthroplasty - registers in countries like Sweden have been improving the practical operations and both realizing significant cost savings at national level by reducing the revision burden results. In Germany a similar arthroplasty - register has not yet been introduced.  METHODS: This study examines the trends in the German health care system which influences the development of clinical numbers in the field of arthroplasty and makes forecasts to 2020 on the basis of the BQS - data. In a further step this study takes the experiences and the results of existing arthroplasty – registers especially from Sweden into account and makes use of it for the situation in Germany. The aim is to identify possible cost savings when introducing such a register in Germany.   RESULTS: The introduction of a German arthroplasty – register for hips seems to make an important contribution to the quality of medical care. In addition considerable cost savings on a national basis might be realized by reducing the revision burden, which exceed the cost of an arthroplasty – register by far.  CONCLUSIONS: If the revision burden for hip arthroplasty could be reduced by one percentage point cost savings of about €14 – 23 million per year could be realized. A reduction of about 50 per cent like in Sweden cost savings about €81 – 216 million per year could be expected. The results of this study might be a basis of discussion among policy – makers.