Abstract
Introduction
Rationing of orthopaedic services is increasingly being used by Care Commissioning Groups (CCG) within the United Kingdom to restrict the numbers of patients being referred for Total Hip Arthroplasty (THA). In Devon, only patients with an Oxford Hip Score (OHS) less than 20 are referred on for specialist Orthopaedic Review. The aim of this study was to look at long term outcomes after THA to see if this rationing has any rational base to justify its use
Methods
Consecutive patients undergoing THA in Exeter between 1996 and 2012 had OHS' collected prospectively pre-operatively and a minimum of 4 years post-operatively. These scores were analysed looking for trends in patient related outcome scores.
Results
2341 patients had an OHS at a minimum of 4 years' post-op (mean 4.97 years, SD 0.33, range 4.0–5.5). This accounted for just under 50% of patients operated on in this period. Average improvement in OHS post THA was 19.6 points (range 0–44). 45.7% of patients undergoing THA had a pre-operative OHS of greater than the CCG threshold of 20. Patients did have a significantly better increase in post-operative OHS when their starting score was less than 20 but patients above this threshold still had a significant benefit from THA. However, patients with a pre-operative OHS less than 32 seemed to have more benefit from THA compared to those with a pre-op OHS of greater than 32. Interesting 7.8% of patients did not achieve the mean detectable change of 5 points in OHS at a minimum of 4 years' post THA.
Conclusion
Rationing has been introduced in many CCG's around the country. Little of the rationing decisions have their basis in scientific fact and reasoning. Our data would suggest that 92.2% of patients undergoing THA have excellent outcomes. If rationing were to be fully patient centred all patients with an OHS less than 32 should be considered for THA.
