OBJECTIVE: To compare the lifetime risk of total hip replacement surgery (THR) for osteoarthritis (OA) between countries, and over time. METHODS: Data on primary THR procedures performed for OA in 2003 and 2013 were extracted from national arthroplasty registries in Australia, Denmark, Finland, Norway and Sweden. Life tables and population data were also obtained for each country. Lifetime risk of THR was calculated for 2003 and 2013 using registry, life table and population data. RESULTS: In 2003, lifetime risk of THR ranged from 8.7% (Denmark) to 15.9% (Norway) for females, and from 6.3% (Denmark) to 8.6% (Finland) for males. With the exception of females in Norway (where lifetime risk started and remained high), lifetime risk of THR increased significantly for both sexes in all countries from 2003 to 2013. In 2013, lifetime risk of THR was as high as 1 in 7 women in Norway, and 1 in 10 males in Finland. Females consistently demonstrated the highest lifetime risk of THR at both time points. Notably, lifetime risk for females in Norway was approximately double the risk for males in 2003 (females: 15.9%, 95% confidence interval (CI) 15.6% to 16.1%; males: 6.9%, 95%CI 6.7% to 7.1%) and 2013 (females: 16.0%, 95%CI 15.8% to 16.3%; males: 8.3%, 95%CI 8.1 to 8.5%). CONCLUSION: Using representative, population-based data, this study found statistically significant increases in the lifetime risk of THR in five countries over a 10-year period, and substantial between-sex differences. These multi-national risk estimates can inform resource planning for OA service delivery. This article is protected by copyright. All rights reserved.