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Thursday, April 15, 1999 Published at 23:10 GMT 00:10 UK


'Hip replacements for all'

Some authorities restrict hip operations

The NHS could afford to provide all the hip replacements that are needed, according to a report.

At the moment, some health authorities restrict use of the procedure, saying it is not cost-effective.

A recent BBC News Online survey suggested that at least 5% of health authorities restricted provision of the operation.

But a study published in The Lancet on Friday claims the number of patients currently denied treatment is so low it would not take much to give them the surgery they need.

One researcher says it could pave the way for appointments for surgery instead of a place on a "vague waiting list".

National guidance

The research, funded in part by the Department of Health, will be sent to the National Institute for Clinical Excellence (NICE) for consideration.

NICE is charged with drawing up national guidelines as to which patients should get which treatments and under what circumstances.

[ image: Researchers believe the NHS can afford all necessary hip surgery]
Researchers believe the NHS can afford all necessary hip surgery
Professor Stephen Frankel, of the social medicine department at Bristol University, led the research.

It found that at the moment, the NHS provides 43,500 total hip replacements each year.

The researchers estimated that the number of people who need such hip surgery in the UK exceeds this figure by 3,100.

Writing in The Lancet they said this is a target that can be realistically met within the NHS budget and there should be no need for rationing.

Rationing NHS treatments

Professor Frankel told BBC News Online: "Rationing is this blurred area - you could say that people waiting a long time are being rationed simply by waiting."

This is because they may die while they wait for the treatment, he said.

"But if there were agreement that these sort of criteria are the right ones you would have to treat these sorts of numbers of people, which is clearly within the capacity of the NHS.

"You would then reach a stage when people don't go on a vague waiting list but you get an appointment - so you know when you're going to get it."

This would also involve denying treatment to some patients who felt they deserved it, he said, but that would in turn lead to more realistic expectations of the health service.

"Anyway, a lot of the time these conditions improve with time, or other (non-surgical) interventions may prove more effective."

Study group

Professor Frankel and colleagues approached a sample of 26,046 people older than 35 years.

The screening consisted of two parts - first, a questionnaire, and second, a clinical examination.

Of those approached, 22,978 responded to the questionnaire.

Within this group, 3,169 reported hip pain and 2,018 were invited for the clinical examination.

The researchers found that the number of severe hip disease requiring surgery was about 15.2 per 1000 people, with an annual incidence of 2.23 per 1000 people per year.

This gave them the figure of 46,600 operations per year.

Setting standard criteria

Writing in The Lancet, the researchers said: "There is no fundamental reason why primary total hip replacement surgery should be denied to those who would benefit from it."

However, it would be up to specialists to agree for whom this type of surgery is the most effective form of treatment.

Professor Frankel said that such a decision should be the responsibility of NICE.

Age Concern said one concern was that patients may miss out on treatment because of their age.

A spokesperson said: "Decisions about who gets what should not be made behind closed doors or in an ad hoc fashion.

"It is essential that we have informed public debate to ensure that older people are not barred from treatment because of their age."

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