OBJECTIVES: Currently, in Rio de Janeiro state, barriers to patient care who require elective surgical procedures in orthopedics are found, thus many patients remain long periods on hold until the attendance. This study aims to analyze the frequency of hospitalization procedures (HP), total inhospital cost (IC), and total number of inhospital days (ID) related to orthopedic elective procedures in Rio de Janeiro state, Brazil, from the public perspective in order to identify potential barriers of access. METHODS: Orthopedic procedures that require hospitalization were selected from the public official hospital information system, for the year 2011. These procedures were separated into elective or urgent according to treatment indication, and validated by an expert panel. Costs are expressed in 2012 Brazilian Real (BRL). A public secondary database was accessed to evaluate HP, IC, and ID separated by cities. RESULTS: Rio de Janeiro state is composed by 92 municipalities. Total population consists of 15,989,929 inhabitants, and 6,320,446 (39.53%) live in the capital (Rio de Janeiro city). In 2011, 18,564 elective HP were performed, with a total IC of 21,977,085 BRL, and 145,295 ID. Data from the capital show 10,724 elective HP, total IC of 14,399,281 BRL, and 98,458 ID, which represent 57.77%, 65.52%, and 67.76% of the state, respectively. When only urgency procedures were analyzed, these rates fell to 43.73%, 46.46%, and 49.35%, respectively. CONCLUSIONS: Hospitalizations for elective orthopedic procedures in Rio de Janeiro state do not present homogeneous distribution among municipalities. The capital houses less than 40% of total population and accounts for more than 65% of costs and inhospital days. Data suggest that municipalities are able to absorb urgency occurrences, but not elective ones, creating difficulties for the treatment of patients in need of elective procedures. Decentralization of care may be able to reduce such barriers.