UCL researchers found significant improvements in care over the past decade
The change since a national review launched by orthopedic surgeons in 2012 is likely to have saved the NHS hundreds of millions of pounds.
A study of the changes confirmed that two less effective treatments, cementless hip implants and knee arthroscopy, were not as common now.
Author Dr Helen Barratt, an expert in public health medicine at UCL, said: “There have been a number of improvements in the care of NHS patients undergoing hip and knee replacement surgery in England over the the last 10 years.
“Hospitals are now more likely to use procedures that reflect the best research evidence.
“For example, older patients who undergo hip replacement surgery are more likely to receive an implant that is secured to healthy bone using bone ‘cement’, an approach that means the implant is less likely to wear out during surgery. his life”.
Cementless implants are made of material with a rough surface, which allows bone to grow over the implant and hold it in place.
A 2012 report led by surgeon professor Tim Briggs recommended that its use be reduced in favor of cemented implants, which are less likely to need revision.
Launched the Getting It Right First Time (GIRFT) program for orthopedics. Other measures included reducing the use of a type of minimally invasive surgery called knee arthroscopy.
The UCL-led team analyzed data from 700,000 patients who underwent hip or knee surgery at 126 NHS centers between April 2009 and March 2018. They also interviewed more than 50 NHS staff.
The study, published in BMJ Open, found substantial improvements when comparing the 2009-12 and 2015-18 periods.
There was a 29 percent drop in the number of cementless hip implants for those over 65 years of age. And the use of knee arthroscopy before knee replacements dropped by 58 percent.
The average levels of function and quality of life of the patients six months after surgery improved. And the typical length of hospital stay was reduced by about a day.
The researchers were unable to say exactly how much GIRFT had caused the changes or assess the economic impact.
But the NHS estimates that it has reduced the number of days orthopedic patients spend in hospital by a third for hip and knee replacements and by 11 percent for neck fractures.
This equates to 276,000 fewer bed days per year, likely to save hundreds of millions of pounds over the past decade.
GIRFT has expanded to over 40 medical specialties and Prof Briggs was recently appointed NHS Clinical Lead for Elective Backlog Recovery.
He said: “The UCL study highlights the contribution of GIRFT to improving clinical practice in orthopedics and we welcome its key findings of improved outcomes for patients undergoing hip and knee procedures in the last ten years.
“We continue to support clinicians and managers in using the GIRFT data methodology across over 40 specialties to drive real change and ensure we deliver the best quality of treatment and care in the NHS.”
Dr Wendy Holden, a medical adviser for the charity Arthritis Action, said patients could expect fewer complications or unnecessary surgeries.
She said: “It’s great to see these big improvements. Orthopedic surgeons, managers, and trusts have worked hard over the past 10 years to improve surgical care so that it is now high-quality, evidence-based, and consistent across the country.”
The improvements are vital for arthritis patients who want to know that their operation will relieve pain and restore function for many years, Dr. Holden said.
She added: “GIRFT has also saved the NHS hundreds of millions of pounds and improved the efficiency of operational listings.
“Once the Covid surgical delay is removed, arthritis patients can expect much shorter wait times and fewer canceled procedures.”
Meanwhile, a report suggests that the pandemic disruption to NHS operations in 2020 was worse than for any other European health system for which data was available.
The State of Health report from the Organization for Economic Co-operation and Development showed that hip replacements in the UK fell by 46%, knee replacements by 68% and cataract surgery by 47 %, compared to 2019.
The averages among the European Union nations were 14, 24, and 23 percent, respectively.
The UK was also second for the drop in cancer surgery with a 26 per cent drop.
More effective treatments mean recovery times have improved
Arthritis in my hips made me feel like a wobbly table, patient says
Lucy Morley Williams waited 18 months for a right hip replacement after a referral from her GP.
She has suffered from arthritis for 15 years, which caused structural problems in her hips, making her “feel like a wobbly table.”
Lucy, 53, was eventually treated at a local private hospital, paid for by the NHS as part of a campaign to remove the Covid backlog.
His surgery in November 2021 went well but his recovery process was complicated.
After dislocating her hip last December, she spent three hours on the ground waiting for paramedics and then three nights in the hospital.
Lucy said: “I am now back on crutches and spent long days in the NHS hospital. The attention from doctors, nurses, physios, occupational therapists is great.
“I think St Richards Hospital in West Sussex deserves its outstanding rating.
“I have been referred back to the falls team for specific help for my joints and help dealing with falls.”
Lucy said that her quality of life had improved since the hip replacement. She has been able to get off very strong painkillers and she no longer needs stools in the house to rest.
He added: “Arthritis doesn’t get the attention it deserves, as many people view it as not life-threatening and therefore not as urgent as other diseases.
“But the truth is that it weakens life. I am in constant pain due to my arthritis. The NHS is so overburdened these days, and there are so many people in pain.”