Trends in hip and knee joint replacement: socioeconomic inequalities and projections of need

Abstract

Objectives: To examine trends in primary and revision joint (hip and knee) replacement in England between 1991 and 2000. Methods: Analysis of hospital episodes statistics between 1 April 1991 and 30 March 2001 for total hip replacement (THR) and total knee replacement (TKR). Descriptive statistics and regression modelling were used to summarise patients' demographic and clinical characteristics and to explore variations in joint surgery rates by age, sex, and deprivation. Results: Between 1991 and 2000, the incidence of primary THR increased by 18%, while the incidence of revision THR more than doubled. The incidence of primary TKR doubled, with revision TKR increasing by 300%. Over the 10 year period, the proportion of THR episodes that involved revision operations rose from 8% to 20%. Substantial variations in operation rates by socioeconomic status were seen, with the most deprived fifth of the population experiencing significantly lower rates. Projections estimate that primary THR numbers could rise by up to 22% by the year 2010, with primary TKR numbers rising by up to 63%. Conclusions: Provision of joint replacement surgery in English NHS hospitals has increased substantially over the past decade. Revision operations in particular have increased markedly. The growth in primary operations has mostly occurred among those aged 60 years and over; rates among young people have changed very little. There is a significant deprivation based gradient in rates. If current trends continue there would be almost 47 000 primary hip and 54 000 primary knee operations annually by 2010.

Education Attainment is Associated With Patient-reported Outcomes: Findings From the Swedish Hip Arthroplasty Register

“…Their willingness to undergo surgery however is equal to their more educated peers; therefore, patient willingness does not account for the treatment discrepancy [11]. The disparity between patients with OA with low socioeconomic status and access to total joint surgery exists even in countries with equal access to health care [5,6,11]. Although these individuals are at risk for lower patient-reported outcomes than more educated patients, they still have marked improvements and benefit from the treatment.…”

Total Knee Arthroplasty in the Elderly: Does Age Affect Pain, Function or Complications?

“…Currently 5% of all TKAs are performed in patients 85 years or older [3,19], but with large expansions in this population group expected [10], it is probable the elderly will account for a greater proportion of cases in future years. Furthermore, with increased awareness of TKA, it can be expected demand will increase [9,15]. Although TKA reduces pain and improves function in general populations of patients with joint disease [21], such postoperative outcomes as these in the octogenarian population are unclear.…”

Severely compromised quality of life in women and those of lower socioeconomic status waiting for joint replacement surgery

“…Recent research from the United Kingdom showed that individuals who received means-tested welfare benefits were less likely to have knee arthritis managed by a hospital consultant and were less likely to be on a waiting list for knee replacement, compared with individuals who were not receiving benefits (10). Further research has also reported lower rates of hip and knee replacement in the United Kingdom for persons with the lowest socioeconomic background (11). A similar disparity in surgery rates also exists in the United States, with differences in health beliefs, economic, and personal resources cited as possible causes (12).…”

“…Potential contributing factors may include increased difficulty obtaining health care information, lower health literacy, or reduced access to health professional services. Studies conducted in the United States and the United Kingdom found that patients with the lowest socioeconomic status had significantly lower rates of joint replacement, but explanations for these findings have been limited (11,26). An increased aversion to undergo surgery is unlikely to be responsible, because a Canadian study reported that patients from lower socioeconomic backgrounds were equally willing to undergo joint replacement when compared with those of higher socioeconomic status (27).…”