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The Partnership’s Improving Planned Care Programme is reviewing local commissioning policies and clinical pathways for planned care services to make sure they follow the most up-to-date clinical guidance and are evidence-based. By introducing single policies and pathways for the whole region, we are adopting a consistent approach across West Yorkshire and Harrogate and removing any unnecessary differences in care that may currently exist.
The West Yorkshire and Harrogate Joint Committee of Clinical Commissioning Groups met in public on Tuesday 14 January 2020 where it agreed the adoption of single commissioning policies for hip replacement surgery and arthroscopic hip surgery, to be implemented across the region within the next 12 months. Both policies align to our new musculoskeletal (MSK) pathway that sets out the various steps in the care of people referred onto MSK services by their GP or other healthcare professional.
Around 480,000 people in West Yorkshire and Harrogate are living in areas that are in the top 10% of the most deprived locations in England. These tend to be the most urban and densely populated parts of the region and we know that fewer people are having hip replacements in these locations, compared to other areas. There are many factors that contribute to these findings such as ethnicity, lifestyle factors, age and socio-economic barriers for example, but having a standardised MSK pathway and single MSK commissioning policies, including hip surgery policies, for the whole region will help to make sure that access to services is fair.
Hip replacement surgery
Many older people are affected by arthritis of the hip as a result of wear and tear in the hip joint. Most would not benefit from having a hip replacement and can manage their symptoms very well but for some people, hip replacement surgery is the best option. This type of surgery (also known as ‘hip arthroplasty) involves replacing a damaged hip joint with an artificial joint.
The new policy for hip replacement surgery states that the procedure will be offered to adults with significant symptoms of hip arthritis, including intense pain and / or limited mobility, where non-surgical management has had no beneficial effect.
Arthroscopic hip surgery
Hip arthroscopy is a type of keyhole surgery carried out using an ‘arthroscope’. This is a thin, metal tube with a small camera at one end that is connected to a monitor, allowing the surgeon to view the inside of the hip joint. The procedure can be used to diagnose problems with the hip joint and in some cases, the surgeon will be able to repair or remove any damaged tissue or cartilage there and then.
The new policy states that arthroscopic hip surgery will be available for children and adults with suspected femoroacetabular impingement (FAI) or labral tears, where non-surgical management has had no beneficial effect. FAI is where extra bone grows in one or both of the bones in the hip joint causing them to rub against each other. Over time, this can damage the joint, limiting movement and causing pain. A labral tear is an injury to the labrum which is the soft tissue that covers the hip socket. Symptoms of a labral tear include hip pain and / or stiffness.
Before hip surgery is offered, an individual would be required to try non-surgical options such as increasing their physical activity, taking non-steroidal anti-inflammatory drugs (NSAIDs) or analgesic drugs to relieve pain, or using a walking aid for example. If alternative treatments have been carried out for a period of around three months with no benefit to the individual, then the appropriate hip procedure would be offered.
Anyone considering hip surgery should have an assessment of their Body Mass Index (BMI). For some people with hip pain, becoming more active and / or losing weight can have a significant impact on the severity of their symptoms and improve their quality of life without having to go through surgery. And for those who do have hip replacements, being a healthy weight and being more active increases the chances of regaining normal functioning and reducing pain and stiffness after surgery.
As with most types of surgery, it’s important that clinicians talk to their patients about other lifestyle factors such as smoking and alcohol consumption that may increase the risks of having an operation and influence their long-term outcomes after having surgery. People having a planned operation, particularly major surgery like a hip replacement, must also be aware of how long rehabilitation is likely to take and what they’d need to do after surgery to make sure that the best possible outcome is achieved. After this conversation, the individual and the clinician can then reach a shared decision whether to proceed with the surgery or not.