Introduction: Long waits for total hip joint replacement (THJR) surgery affect quality of life and are likely to impose significant medical, personal and other costs on individuals and society.

Aim: To define the economic and health costs of waiting for THJR surgery.

Method: A prospective study of 130 patients requiring primary THJR is being undertaken. Data on health related quality of life (HRQL), using self completed EQ-5D and WOMAC questionnaires, are collected on enrolment, and every month before surgery and continuing for six months after surgery. Monthly cost diaries are used to record medical, personal and other costs. Inferential statistics and regression analyses will be used to test the strength of associations between costs and waiting times, and changes in HRQL before and after surgery.

Results: Preliminary results indicate that costs are greatest before surgery (mean=$70.41 per person, per month), remain high during the first month after surgery (mean=$53.24 pp pm), and drop significantly (p< 0.05) within six months after surgery (mean=$12 pp pm). WOMAC scores of pain, stiffness and physical function show significant improvements (p< 0.05) within three months after surgery. The EQ-5D also indicated significant (p< 0.05) positive changes.

Conclusions: The preliminary results suggested that patients had high dependency levels for the first month after surgery. Consequently, costs associated with recuperation after surgery may have shifted from the public hospitals onto the community and family. Significant improvements in HRQL by three months after surgery indicated that THJR is a successful intervention for osteoarthritis.

Introduction: Hip fractures in the elderly create an economic and social burden on individuals and society. Earlier predictions of the incidence of hip fractures in the older adult population showed that by the year 2011 the rate would rise to epidemic proportions.

Aim: To analyse the actual hip fracture rate from 1988 to 1999 and then to compare it with the hip fracture rate predicted by Rockwood, Horne and Cryer in 1990.

Method: Data on the number of patients admitted to New Zealand hospitals with a diagnosis of fractured neck of femur were obtained, and compared with Rockwood’s (1990) weighted regression and baseline predictions. Poisson regression was used to test for changes in hip fracture rates over time.

Results: The numbers of hip fractures for females, from 1988 to 1993, were similar to the numbers predicted, yet have been significantly lower than stated predictions since 1995 (all age bands, P < 0.002; in the 85+ group, p < 0.0001). For males, hip fracture numbers are closer to those predicted, and since 1995 are less than the weighted regressions predicted. The difference was not statistically significant.

Conclusions: Despite the absence of a nationally agreed and coordinated strategy aimed at osteoporosis prevention, it appears that the use of risk assessments, osteoporosis prevention strategies, in combination with improved retirement home and personal care interventions and treatments are likely to have contributed to this situation. The 4.6% drop in the age group most at risk of hip fracture (85+), may be a contributing factor.