Over 160,000 people with severe hip or knee pain caused by osteoarthritis have joint replacement surgery annually but very little is known about how they access surgery. Their journey begins by consulting their GP but patients still take varied routes after developing symptoms. Available treatments range from pain killers and physiotherapy to joint replacement surgery.
Across the UK the treatments and models of care vary widely and patients may be unable to access some treatments based on where they live. National guidelines have been published about which treatments the NHS should offer, and that surgery should only be used if non-surgical treatments have failed. However, it remains unclear which pathway is best for patients, or most cost effective for the NHS. It is uncertain whether some patient groups (e.g. older people or those living in poorer areas) are less likely to be offered surgery.
This study aims firstly to describe patients’ pathways from first GP presentation until definitive treatment. Secondly, we will investigate the hypothesis that treatment pathways differ according to patients’ characteristics such as age or where they live. Thirdly, in those undergoing surgery, we will investigate the hypothesis that timing and duration of pathways affects surgical outcomes.
Objective
To identify patients that undergo hip and knee replacements and describe the treatment pathways taken to identify whether there is any variation according to patient characteristics (age, sex, social class, body mass index (BMI), comorbidities, medications, smoking status etc.) and geographical region. We further aim to investigate whether the treatment pathway and its’ duration affects the outcome of hip or knee replacement surgery.
Methods
determine whether they change as patients progress through the pathway.
b. Describe whether patient characteristics and geographical region are associated with timing to receive treatments, and further describe variations according to whether or not patients receive both surgical and non-surgical treatments.
3. Does the duration or pattern of treatment pathway prior to referral to a surgeon affect patient outcomes of surgery?
a. In patients that ultimately received hip or knee replacement surgery, do differences in the treatments offered during the pathway affect patient outcomes of surgery?
b. In patients that ultimately received hip or knee replacement surgery, does the duration of the treatment pathway affect patient outcomes of surgery?
c. Are there any definable patient characteristics or regional variations that influence the outcome of treatment?
Rationale
OA is one of the most common diseases worldwide. It is a chronic, progressive, disabling disease with many factors influencing its development and progression. Relatively little is still known about how patient experiences and socioeconomic status effects access to care and outcome of treatment. Further understanding the referral patterns and different routes of access to care for OA patients and their wider characteristics can inform, and enhance
Mortality • PROMS • Failure / Revision surgery
• Prosthetic Joint Infection • Healthcare Costs • Incidence of arthroplasty
• Venous Thrombeoembolism • Readmission for MI, CVA, PE • Healthcare related quality of life
Andrew Judge - Chief Investigator - University of Oxford
John Broomfield - Corresponding Applicant - University of Oxford
Antonella Delmestri - Collaborator - University of Oxford
Daniel Prieto-Alhambra - Collaborator - University of Oxford
Sion Glyn-Jones - Collaborator - University of Oxford
HES Admitted Patient Care;HES Outpatient;HES PROMS (Patient Reported Outcomes Measure);ONS Death Registration Data;Patient Level Index of Multiple Deprivation