Hip and knee surgery

Hip fracture repair is usually an emergency procedure. Evidence suggests that early surgical intervention – within 48 hours – improves patient outcomes and minimises the risk of complication. Time to surgery is influenced by many factors, including hospitals’ surgical theatre capacity, flow and access, and targeted policy interventions. In 2019, on average across OECD countries, almost 80% of patients admitted for hip fracture underwent surgery within two days (Figure 6.19). COVID-19 had a significant impact on hospital capacity and function. For countries that were able to provide 2020 data, Latvia saw improvement, Lithuania saw a reduction, and Ireland, Iceland and Portugal maintained rates close to 2019 figures.

Osteoarthritis is among the most prevalent diseases in many OECD countries. It typically manifests as pain and stiffness in weight-bearing joints such as the hip and knee. Treatment of osteoarthritis of the hip and knee aims to reduce the patient’s joint pain and improve their function, mobility and quality of life. Joint replacement surgery is generally recommended if symptoms persist after exhausting non-surgical treatment such as physical therapy and weight loss. Rates of elective hip and knee replacement have risen over the past decade, and the number of people undergoing these procedures in OECD countries each year is fast approaching a total of 2.5 million.

Patient-reported outcome measures (PROMs) can be used to assess the effect of a medical intervention from the patient’s perspective. The Oxford Hip/Knee Score and the Hip/Knee Disability and Osteoarthritis Outcome Score – Physical Short Form (HOOS-PS/KOOS-PS) are among the most common condition-specific PROMs used in hip and knee replacement surgery. Common generic instruments include the EuroQol Five Dimensions (EQ-5D) questionnaire (OECD, 2019[30]).

Figure 6.20 shows the mean change on the Oxford Hip Score and HOOS-PS scales reported by patients after elective hip replacement surgery for osteoarthritis in an international set of joint replacement registries. Results have been adjusted for preoperative score and for the age and sex of the patient cohort. The average mean adjusted change reported across the participating registries was +21 on the Oxford Hip Score (equating to 44% improvement) and +33 on the HOOS-PS scale (equating to 33% improvement).

Figure 6.21 shows the adjusted mean change reported by patients using the Oxford Knee Score and KOOS-PS after elective knee replacement surgery for osteoarthritis. The average mean adjusted change was +17.6 on the Oxford Knee Score (equating to 36% improvement) and +21.1 on the KOOS-PS (equating to 21% improvement) – more modest than the average improvement reported by patient who underwent hip replacement.

The average mean change on the EQ-5D index – adjusted for preoperative score, age and sex – across participating registries was +0.25 for patients after elective hip replacement surgery (equating to 25% improvement) and +0.19 after knee replacement surgery (equating to 19% improvement). The results suggest that – all other things being equal and compared to a no-intervention alternative – the average 65-year-old patient who underwent a hip replacement in the participating registries gained the equivalent of about five years in “full” health; the average patient who underwent knee replacement gained over three years.

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