Inequalities in accessing hip joint replacement for people in need

Objectives: To quantify the effects of rurality and socio-economic disadvantage on prior evidence of need for total hip joint replacement and use of health services after adjusting for age and gender. Design: Self-completion validated questionnaire mailed directly to subjects. Settings: Geographical areas covered by Wiltshire and Sheffield Health Authorities in England. Participants: Random stratified sample of 15,000 aged 65 years and over taken from the central age-sex registers. Main outcome measure: Prior need for hip joint replacement surgery and whether general practice and hospital services were being used as assessed by the questionnaire. Results: The response rate was 78% after three mailings. Prevalence of need for total hip replacement in the over 64s was 3.4% (95% confidence interval is 3.0% to 3.8%) and in those without co-morbidity 5.4% (95% confidence interval is 4.8% to 6.0%). There were inequalities demonstrated due to age, geography, and deprivation, but not rurality in accessing general practice and hospital services. People who were poor had more need. Older people in need were less likely to be accessing health services. Conclusions: There is an important unmet need for hip joint replacement in older people with marked inequalities in levels of need and use of services. The use of numbers of people waiting as a performance indicator is perverse for this procedure. We have urgently to expand orthopaedic services and the training of orthopaedic surgeons in England.