Inequality in the Provision of Knee and Hip Replacements

by Pamela
(Hip Replacement and Recovery)

A study published today in the BMJ (BMJ 2010;341:c4092) details the inequality in provision of hip and knee replacements within England.

The data is a bit out of date (2002) and it is suggested that the situation may have improved since that time. Nevertheless it makes interesting reading.

The authors started off by predicting the expected need for both hip and knee replacements across a number of different groups. They then compared these figures with what was actually provided.

General Provision of Knee and Hip Replacements

The general conclusion was that, at the time of the study, there was an under-provision of knee and hip replacement surgery relative to predicted need. The authors demonstrated that people between 50 to 84 years all had the same need for surgery but that those in the 60-84 year old group were twice as likely to receive it. People over 85 were the least likely to receive surgery.

Breakdown of Areas of Inequality

• Gender

Men received 8% more hip replacements and an astonishing 31% more knee replacements relative to their need compared with women.


• Socio-economics

Affluent areas were far better served with patients from deprived areas receiving about 70% less provision relative to need compared to those from wealthy areas. This finding held true for both hip and knee replacements.


• Ethnicity

The picture here wasn't so straightforward with no difference found between different ethnic groups when it came to hip replacements but with people from non-white areas receiving a higher provision of knee replacements than people from predominantly white areas.


• Urban versus Rural

Townies got a higher rate of knee replacements then predicted when compared with their country cousins but the rural areas had a higher rate of hip replacements relative to their need.

It would be good to think that the situation had improved since 2002 but even if it had it is hard to predict the future. The massive cuts to the NHS must result in a decrease in service provision. Whether these cuts will be applied equitably is open to question and further study.