PREOPERATIVE HIP AND KNEE ARTHRITIS SEVERITY UNDER DIFFERENT HEALTHCARE DELIVERY SYSTEMS

Abstract

Purpose: The purpose of the study is to compare the disease severity at the time of surgical intervention between patients undergoing primary joint replacement under the National Health Service and Private Health-care Systems.

Materials: 166 patients were included in the study – 101 NHS and 65 Private. Inclusion criteria were: 1) hip or knee osteoarthritis, 2) primary joint replacement, and 3) informed consent of the patient. Patients with arthropathy of inflammatory, infectious or neoplastic aetiology were excluded. Physician evaluation included medical history, calculation of Charleson Comorbidity Scores, and Knee Society rating. Patients were given self-assessment health questionnaires including WOMAC, SF-36, and Nottingham Health Profile.

Results: Mean age was 69.4 years and did not vary significantly between NHS and Private groups. Charleson Comorbidity Scores were significantly worse in the NHS group than in the private. Health assessment questionnaire scores were all adjusted for age, sex, and comorbidity. In NHS patients undergoing TKR, we demonstrate significantly worse pre-operative comorbidity than in private group for indices of function and pain. Patients undergoing THR showed little difference in pre-operative comorbidity.

Conclusion: NHS patients undergoing primary TKR have significantly more advanced disease than their counterparts who are privately insured. Access to TKR surgery is determined by the healthcare delivery system rather then a threshold level of disease severity. Further follow-up of the outcomes of TKR in these two groups needs to be carried out to determine the long-term effects of accessing surgical care at a more advanced stage of disease.