Patients' views on total joint replacement in the UK

Approximately 70,000 hip and knee procedures are performed in English hospitals each year [1], causing lengthy waiting lists for total joint replacements (TJR) within the National Health Service (NHS). Most patients have to wait for many months for an initial appointment to see an orthopaedic surgeon, and a further 6-18 months before they are put on the TJR waiting list. Some wait for shorter times than others, and a proportion of those referred to NHS surgeons for consideration of joint replacement are not put on the waiting list, being told that surgery is not appropriate for them. These findings imply that choices are being made as to who should have an operation and which cases should be prioritised [2, 3]. There are also concerns about unmet need for treatment of severe arthritis in the UK and underprovision of total knee joint replacements [4, 5]. Recent reviews have highlighted variations in surgical activity at both national [1] and international levels [6], with the US, for example, having much higher rates of total knee replacement (TKR) than the UK. Rates of TJR also vary by age, gender, ethnicity and, socio-economic status [7, 8], despite there being no evidence that such factors affect outcome [7- 9]. © 2009 Springer-Verlag Berlin Heidelberg.