A single approach to knee surgery for West Yorkshire and Harrogate

The West Yorkshire and Harrogate Joint Committee of Clinical Commissioning Groups met in public on 5 November 2019. At this meeting, the Joint Committee agreed the adoption of single commissioning policies for knee replacement surgery (arthroplasty) and keyhole surgery on the knee (arthroscopy). The new standardised knee policies will be implemented across West Yorkshire and Harrogate within the next 12 months.

Knee replacement surgery (arthroplasty) involves replacing a damaged, worn or diseased knee with an artificial knee joint. The new policy states that knee replacement surgery will be available to people with osteoarthritis of the knee, or severe disease, which causes moderate to severe joint pain and limited function in the knee which results in difficulty walking or with performing daily activities.

Keyhole surgery on the knee (arthroscopy) is carried out to treat problems with the knee joint such as inflammation or an injury and may involve repairing or removing damaged tissue or cartilage. The new policy states that this type of surgery will be available to people who do not have osteoarthritis but who have knee pain and ‘mechanical’ symptoms of the knee such as locking where the joint becomes temporarily ‘stuck’.

Before knee surgery is offered, an individual would be required to try ‘conservative management’ 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. This stage is particularly important when considering knee replacement surgery because some people with knee pain will not gain benefit from a knee replacement beyond that offered through conservative management.

Good communications between the clinician and the person considering knee surgery is extremely important, not just to go over the potential benefits of having surgery but to also understand the associated risks. Anyone considering knee surgery should also have an assessment of their Body Mass Index (BMI) and smoking status, as well as other lifestyle factors that may increase the risks of having an operation and influence their long term outcomes after having surgery. Individuals 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. The individual and the clinician can then reach a shared decision whether to proceed with the surgery or not. If alternative treatments have been carried out for a period of around three months with no benefit to the individual then the appropriate knee surgery would be offered.

Patients undergoing knee surgery that delivers no measurable benefit to their health and wellbeing add to waiting lists and prevent patients who would benefit from such clinical procedures having to wait longer for those procedures. In adopting a standardised approach to these knee procedures, we are addressing the variation in care reported by people across West Yorkshire and Harrogate, otherwise known as the ‘postcode lottery’. This consistent approach will help to make sure that people in different parts of our region have the same access to health care services no matter where they leave, and that they have a similar experience of care.

West Yorkshire and Harrogate Health & Care Partnership is hosted by NHS Wakefield Clinical Commissioning Group.
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