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Elective Total Hip Replacements

• report ( 744Kb)
• executive summary ( 70Kb)

The NHS performs over 30,000 total hip replacements each year, and they are generally highly effective, reducing pain and increasing mobility.

Most patients are implanted with one of a small number of established designs and can expect their new hip to work effectively for some ten to fifteen years. However, there are over 60 different hip prostheses available, and evidence of long term effectiveness is not available for all those in current use. NICE has now issued guidance on this.

There are also widespread variations in areas such as the follow-up of patients after their operation, and the supervision of surgery.

NHS trusts spent £53 million in total on the purchase of prostheses in 1998-99. Many have taken initiatives to reduce purchasing costs, but there is scope for some trusts to do more to reduce costs.

We found many consultants believe that length of stay for hip replacement patients could be reduced from the current average of 11 days, though most trusts have no plans to do so.

In the light of these findings, based in part on major surveys of orthopaedic consultants and NHS trusts, we make 20 recommendations for improving the service provided to patients who require total hip replacements.

Those of interest to Chief Executives are, in particular:

• Trusts should consider restricting the prostheses used to those with long term evidence of effectiveness, in line with the recent recommendations by the National Institute for Clinical Excellence. 
• Trusts should review the scope for improving their prosthesis purchasing procedures to save costs, while maintaining quality standards.
• Trusts should ensure that where operations are carried out by non-consultant grades without consultant supervision, there are effective risk management assessments and procedures in place.
• Trusts should take steps to reduce unnecessary length of stay in hospital.

From NHS Trusts; Department of Health; Medical Devices Agency; Audit Commission; Accounts Commission (Scotland); Age Concern; British Orthopaedic Association; Nuffield Orthopaedic Centre; British Orthopaedic Association; Council of International Hospitals; Hospital for Special Surgery and Hospital for Joint Diseases (New York); US Food & Drug Administration; Government Accounting Office; US Agency for Healthcare Research and Quality; University of Gothenborg; hip prosthesis suppliers and manufacturers.

For further information contact Tim Fry on 020 7798 7290 or email him through our enquiries desk, please mark your email for his attention.

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