Waiting for joint replacement surgery

A team of Bristol University researchers are aiming to find out why some people waiting for a hip or knee replacement have to wait longer than others for surgery.

With funding of £47,650 over two years from the Arthritis Research Campaign, a team at the MRC Research Collaboration at Bristol University will act as a “fly on the wall” during consultations between orthopaedic surgeons and patients, in order to gain a clearer picture of the factors that lead to discrepancies in regional waiting lists.

The aim of the study is to refine and standardise the guidelines governing the process of prioritising patients for surgery across the country.

Dr Rachael Gooberman-Hill, health services researcher and principal investigator at the University, said: “From previous research we know that despite there being national guidelines for surgeons on who should be prioritised for joint replacement surgery, there are inequities in provision.

“We know that some people have to wait longer than others for surgery even if they are in the same amounts of pain and have the same problems with walking.

“What we don't know is what goes on in the decision-making process that perpetuates these inequities, and that's what we want to find out.”

“We hope to shed light on how the decision-making processes are made, and by doing that would hopefully be able to make recommendations about how care can be improved, and patients empowered.”

Among the factors that influence a surgeon's decision to operate are: the level of pain a person is in, the state of their hip or knee joint as identified in an x-ray, and their level of obesity.

There is also evidence that rates of joint replacement surgery are affected by a patient's age (they are either too old or too young), their ethnicity, gender and social class. It is acknowledged that people from a more deprived area are less likely to get treatment.

Starting in July, a trained researcher will sit in on out-patient consultations between four surgeons and 50 of their hip and knee replacement patients, and with their permission will audio-record the discussion. Patients will then be interviewed afterwards about the decision that was made and how they feel about it. Up to 20 patients will then be followed up after surgery to talk about their experience of surgery.

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