Just after Christmas is the worst time to need hip or knee joint replacement - just before is the best, UK

Date: Nov-06-2013Research from the Medical Technology Group reveals that just after Christmas may be the worst time of year to need hip or knee joint replacement - and that just before may be the best time.
Like a postcode lottery, this time-of-year lottery means the outcomes for individual patients can be radically different, in this case dependent on the financial calendar.

March is the busiest month for operations, so patients starting the average 15-week wait for a new hip or knee are better starting their wait just before Christmas. Those who start their wait after Christmas may have the longest wait.

The research shows that over the last ten years there were an average of 498 fewer hip procedures and 641 fewer knee procedures in April than in March, coinciding with the end of the financial year. The implication, the Medical Technology Group report says, is "that financial calendars for trusts are driving outcomes for patients".

There is also new evidence of a postcode lottery in hip and knee treatments, with dramatic variation in waiting times and half of local trusts reporting patients being held back from treatment.

Barbara Harpham, chair of the Medical Technology Group, said: "If you need a new hip or knee, it shouldn't matter when in the year it is, or where in the country you live. There is a postcode lottery and a time-of-year lottery, and it isn't good enough for patients. It is vital that the government stops restrictions on knee and hip operations for people who need them."

The key findings of the report are:

46,501 hip procedures were performed by the NHS in March over the last ten years - compared to 41,519 in April. This is a difference of 4,982 or 11%.

49,351 knee procedures were performed by the NHS in March from 2004 to 2013 - compared to 42,944 in April. This is a difference of 6,407 or 13%.

The postcode lottery persisted in 2012. Patients in London waited 33% longer than patients in the East Midlands for a hip operation in 2012. Londoners waited an average of 121 days compared to 91 days for patients in the East Midlands.

Average waiting times for hip joint replacement were:

HipAverage waiting time in days (2012)Variation from best performing region
London12130 (33%)
South West11221 (23%)
North West10211 (12%)
Yorkshire and the Humber1009 (10%)
South East998 (9%)
North East998 (9%)
Eastern976 (7%)
West Midlands910
East Midlands910

Average waiting times for knee joint replacement were:

KneeAverage waiting time in days (2012)Variation from best performing region
London12128 (31%)
South West11421 (23%)
North East10512 (13%)
Yorkshire and the Humber10411 (12%)
South East10411 (12%)
West Midlands10310 (11%)
North West1018 (8%)
Eastern941 (1%)
East Midlands930

33 (49%) of 67 trusts across England who responded to our Freedom of Information request confirmed that Commissioners are applying more stringent conditions before referring patients to their trust. See Notes below for a full list.

There is also great variation in the number of knee and hip procedures are performed in each region - and by each hospital trust. The trusts that perform more procedures also do them better. See Appendix 1 and Appendix 2 of the report for data by region and by hospital trust.

Demand for hip and knee joint replacement has increased hugely in recent years - up 92% from 72,006 operations a decade ago to 138,281 in 2012.

31 per cent of women and 42 per cent of men receiving an artificial hip are of working age.

In 2009 in the region of 11,000 people in England and Wales were enabled to return to work by a hip replacement surgery, saving the UK welfare system £37.4 million each year of their working lives.

87% of hip joint replacement patients and 78% of knee joint replacement patients report an improved condition after their operation, according the NHS's Patient Reported Outcomes Measures. This is higher than for any other procedure and suggests more hip and knee procedures are one of the best ways to improve outcomes for patients.

The Medical Technology Group is calling for:

Clinical Commissioning Groups to stop imposing more restrictive conditions before they refer patients.

Trusts to ensure greater equity of access throughout the year.

Trusts to have strategies in place to improve patient outcomes from joint replacement.

The report can be downloaded here.

Courtesy: Medical News Today Note: Any medical information available in this news section is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional.