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Ann Rheum Dis. 2004 Nov; 63(11): 1483–1489.
PMCID: PMC1754820

Inequalities in access to knee joint replacements for people in need

Abstract

Objectives: To quantify the effects of socioeconomic deprivation and rurality on evidence of need for total knee joint replacement and the use of health services, after adjusting for age and sex.

Methods: A random stratified sample of 15 000 people aged [gt-or-equal, slanted]65 years taken from central age/sex registers for the geographical areas covered by the previous Sheffield and Wiltshire Health Authorities. A self completion validated questionnaire was then mailed directly to subjects to assess need for knee joint replacement surgery and whether general practice and hospital services were being used. Subjects were followed up for 18 months to evaluate access to surgery.

Results: The response rate was 78% after three mailings. In those aged 65 years and over (with and without comorbidity), the proportion with no comorbid factors and in need of knee replacement was 5.1%; the rate of need among subjects without comorbidity was 7.9%. There were inequalities in health and access to health related to age, sex, geography, and deprivation but not rurality. People who were more deprived had greater need. Older and deprived people were less likely to access health services. Only 6.4% of eligible people received knee replacement surgery after 18 months of follow up.

Conclusions: There is an important unmet need in older people, with significant age, sex, geographical, and deprivation inequalities in levels of need and access to services. The use of waiting list numbers as a performance indicator is perverse for this procedure. There is urgent need to expand orthopaedic services and training.

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Selected References

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  • Jüni P, Dieppe P, Donovan J, Peters T, Eachus J, Pearson N, Greenwood R, Frankel S. Population requirement for primary knee replacement surgery: a cross-sectional study. Rheumatology (Oxford) 2003 Apr;42(4):516–521. [PubMed]
  • Payne JN, Coy J, Patterson S, Milner PC. Is use of hospital services a proxy for morbidity? A small area comparison of the prevalence of arthritis, depression, dyspepsia, obesity, and respiratory disease with inpatient admission rates for these disorders in England. J Epidemiol Community Health. 1994 Feb;48(1):74–78. [PMC free article] [PubMed]
  • Payne N, Saul C. Variations in use of cardiology services in a health authority: comparison of coronary artery revascularisation rates with prevalence of angina and coronary mortality. BMJ. 1997 Jan 25;314(7076):257–261. [PMC free article] [PubMed]
  • Holland R, Harvey I. Population needs assessment and knee replacement surgery. Rheumatology (Oxford) 2003 Apr;42(4):503–506. [PubMed]
  • Fearn R. Rural health care: a British success or a tale of unmet need? Soc Sci Med. 1987;24(3):263–274. [PubMed]
  • Bradley PM. The choice of deprivation in measuring poorer health in Northamptonshire. J Epidemiol Community Health. 1999 Mar;53(3):189–190. [PMC free article] [PubMed]
  • Phillimore P, Reading R. A rural advantage? Urban-rural health differences in northern England. J Public Health Med. 1992 Sep;14(3):290–299. [PubMed]
  • Hawker G, Wright J, Coyte P, Paul J, Dittus R, Croxford R, Katz B, Bombardier C, Heck D, Freund D. Health-related quality of life after knee replacement. J Bone Joint Surg Am. 1998 Feb;80(2):163–173. [PubMed]
  • Scuderi GR, Insall JN, Windsor RE, Moran MC. Survivorship of cemented knee replacements. J Bone Joint Surg Br. 1989 Nov;71(5):798–803. [PubMed]
  • Moran CG, Horton TC. Total knee replacement: the joint of the decade. A successful operation, for which there's a large unmet need. BMJ. 2000 Mar 25;320(7238):820–820. [PMC free article] [PubMed]
  • Hirsch HS. Total joint replacement: a cost-effective procedure for the 1990s. Med Health R I. 1998 May;81(5):162–164. [PubMed]
  • Lavernia CJ, Guzman JF, Gachupin-Garcia A. Cost effectiveness and quality of life in knee arthroplasty. Clin Orthop Relat Res. 1997 Dec;(345):134–139. [PubMed]
  • Wilson MG, May DS, Kelly JJ. Racial differences in the use of total knee arthroplasty for osteoarthritis among older Americans. Ethn Dis. 1994 Winter;4(1):57–67. [PubMed]
  • Katz BP, Freund DA, Heck DA, Dittus RS, Paul JE, Wright J, Coyte P, Holleman E, Hawker G. Demographic variation in the rate of knee replacement: a multi-year analysis. Health Serv Res. 1996 Jun;31(2):125–140. [PMC free article] [PubMed]
  • Woolhead GM, Donovan JL, Chard JA, Dieppe PA. Who should have priority for a knee joint replacement? Rheumatology (Oxford) 2002 Apr;41(4):390–394. [PubMed]
  • Lequesne MG, Mery C, Samson M, Gerard P. Indexes of severity for osteoarthritis of the hip and knee. Validation--value in comparison with other assessment tests. Scand J Rheumatol Suppl. 1987;65:85–89. [PubMed]
  • Tennant A, Fear J, Pickering A, Hillman M, Cutts A, Chamberlain MA. Prevalence of knee problems in the population aged 55 years and over: identifying the need for knee arthroplasty. BMJ. 1995 May 20;310(6990):1291–1293. [PMC free article] [PubMed]
  • Hawker GA, Wright JG, Coyte PC, Williams JI, Harvey B, Glazier R, Wilkins A, Badley EM. Determining the need for hip and knee arthroplasty: the role of clinical severity and patients' preferences. Med Care. 2001 Mar;39(3):206–216. [PubMed]
  • Eachus J, Williams M, Chan P, Smith GD, Grainge M, Donovan J, Frankel S. Deprivation and cause specific morbidity: evidence from the Somerset and Avon survey of health. BMJ. 1996 Feb 3;312(7026):287–292. [PMC free article] [PubMed]
  • Farmer JC, Baird AG, Iversen L. Rural deprivation: reflecting reality. Br J Gen Pract. 2001 Jun;51(467):486–491. [PMC free article] [PubMed]
  • Hawker GA, Wright JG, Coyte PC, Williams JI, Harvey B, Glazier R, Badley EM. Differences between men and women in the rate of use of hip and knee arthroplasty. N Engl J Med. 2000 Apr 6;342(14):1016–1022. [PubMed]
  • Milner PC, Payne JN, Stanfield RC, Lewis PA, Jennison C, Saul C. Inequalities in accessing hip joint replacement for people in need. Eur J Public Health. 2004 Mar;14(1):58–62. [PubMed]

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