Poorest patients more likely to have complications after hip replacement

Patients from more deprived areas are more likely to have complications after having a hip replacement, according to more than a decade of NHS data.

Evaluation of National Joint Registry data of almost 450,000 patients who had a total hip replacement, showed those from the most deprived areas were more likely to experience complications, be readmitted to hospital or need another operation.

There were also differences related to patient reported wellbeing after surgery in terms of pain and function.

But after five years there was no difference by deprivation level for hip replacement revision rates, the researchers reported in PLOS Medicine.

All patients gained equally in terms of patient-reported outcomes albeit from different starting points when they had the hip replacement, the researchers noted.

Overall the average age of those having a hip replacement was 70 years and 61% were women, the figures showed, with more than half categorised as overweight or obese.

The annual number of patients having a hip replacement doubled over the decade looked at.

By 2017, the NHS was doing almost 50,000 operations a year with 24% in the least deprived group and 13% in the most deprived category.

Overall, 0.4% of patients died within 90 days of their surgery with a higher mortality in the most deprived group, the analysis showed.

In the six months after the operation, complications occurred in 5.7% of those from the most deprived areas compared with 4.3% in the least deprived – an increased relative risk of 26%.

Other studies have shown that those in the most deprived groups tend to have greater numbers of comorbidities and be at a later stage of the disease progression before having joint replacement surgery.

Those in the most deprived groups may not be selected for surgery or selected later, the researchers said.

But the data provides information for shared decision-making between patients and clinicians when deciding to undergo hip replacement, the team concluded.

Speaking with Pulse, study lead Professor Andy Judge, professor of translational statistics at Bristol Medical School, said: ‘We know that patients in deprived areas have the greatest need for hip replacement surgery, they have the worst pain and function, and this study shows again they are least likely to get access and when they do they  have slightly worse outcomes.’

He added that those in the more deprived groups tended to present later to their GP which delays referral and the surgery.

‘Because of that worse baseline point, it’s not surprising they have slightly worse outcomes. But even despite that they are still getting massive benefits from this surgery.’

He added it was important to remember complications only impacted a small proportion of patients, but it was still important to counsel them on the risks.

There are also things that can be done prior to surgery to prepare patients, he said. But he acknowledged that waiting lists can be lengthy so improving access for patients from deprived areas was a challenge.

‘You can do prehabilitation and do specific exercises and that may lead to better outcomes. There are some things we can do.’