Old and poor people are less likely to have knee replacement surgery

Old and poor people are less likely to have knee replacement surgery, although their need is often greater than that of younger, more affluent people, reveals a large scale study in the Annals of the Rheumatic Diseases.

The findings are based on a survey of a random but representative sample of 15,000 people aged 65 and above, living in Sheffield and surrounding areas in the north of England, and the county of Wiltshire in the south west.

Of the 11,214 respondents, 4,000 had other illnesses/conditions that precluded surgery. Many of these people were obese. The authors calculated that those who needed surgery totalled 4500 in Wiltshire and 4600 in Sheffield at the end of December 1999.

But almost all of those who were eligible for knee replacements had not the operation after 18 months of waiting. Only 6.4% had had the surgery.

People who were poor were twice as likely to need the surgery as their more affluent peers, but were less likely to be receiving the appropriate services. Those over the age of 75 were also less likely to have the appropriate treatment.

And women were twice as likely as men to need knee replacement, but twice as likely not to be in receipt of treatment for their condition from a family doctor or specialist.

The authors point out that they based their analyses on a threshold score of 14 or above, which indicates extreme levels of discomfort and disability.

But if the figures are re-analysed using a score of 11, to indicate severe levels of discomfort and disability, "the results indicate that there are very large numbers of people who need knee replacement," they say¯equivalent to 13.2% of 65 year olds.

"Consequently, the use of waiting list numbers as a performance indicator is perverse," say the authors, "as lower waiting lists numbers in the context of a large burden of unmet need imply that many people eligible for treatment are not receiving it."

Falls in the waiting lists suggest that the problem is being addressed, despite evidence to the contrary, they say.

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