Rheumatology Advance Access originally published online on April 21, 2006
Rheumatology 2006 45(11):1437-1441; doi:10.1093/rheumatology/kel131
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Need for and receipt of hip and knee replacement—a national population survey
1Primary Care Group, School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ, UK, 2Peninsula Medical School, Universities of Exeter and Plymouth, Exeter and 3Department of Public Health and Primary Care, University of Cambridge, UK.
Correspondence to: Dr Nicholas Steel, Primary Care Group, School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ, UK. E-mail: n.steel{at}uea.ac.uk
Objectives. Hip and knee joint replacements are effective, and yet little is known about how closely the need for joint replacement matches supply in different population groups. Our objective was to compare the prevalence of existing joint replacements with that of need in population groups in England.
Methods. A total of 7101 people aged 60 yrs or older, representative of the population of England, were interviewed. Participants were asked about both receipt and need for joint replacement, socio-economic status and co-morbidity. ‘Need’ classification was based on hip or knee pain and difficulty walking, with adjustment for potential surgical contraindications. Associations between participants’ characteristics and both need and receipt were estimated.
Results. The prevalence of existing joint replacement (receipt) was 6% [95% confidence intervals (CI) 5, 6], and this was lower in the North than the South [adjusted odds ratio (OR) 0.72, CI 0.53, 0.96]. In contrast, the prevalence of estimated need was higher in the North (OR 1.27, CI 1.03, 1.58). Need was greater in women than men (OR 1.30, CI 1.09, 1.53), and showed an increasing gradient from the wealthiest to poorest quintile (ORs 1.00, 1.52, 2.18, 2.49, 3.23). In contrast, receipt did not differ significantly by sex or socio-economic group.
Conclusions. People living in the North of England, women and the less wealthy experience relatively high levels of need, yet do not receive relatively more hip and knee joint replacements.
KEY WORDS: Osteoarthritis, Hip, Knee, Arthroplasty, Socio-economic factors
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