Eligibility for knee and hip replacement may become more restricted in some areas of the UK

People with joint conditions in three areas of the UK could soon find it harder to get access to hip and knee replacement surgery because of changes in eligibility criteria, reports the Health Service Journal.

The Redditch and Bromsgrove, South Worcestershire, and Wyre Forest clinical commissioning groups plan to reduce the Oxford hip and knee score needed to qualify for surgery from 30 to 25, so operations will only be available for people whose disability and pain is severe enough to affect their daily life and sleep habits. It is thought that other clinical commissioning groups are planning similar steps.

Furthermore, only people with a body mass index of less than 35 will be eligible for surgery unless they can show a 10% loss in weight, or if they will experience more joint destruction if surgery is delayed or if they are in danger of losing their independence.

The clinical commissioning groups have attracted criticism, as some believe this may suggest that they are looking to change the scoring system used to decide who is suitable for these operations.

The changed criteria would reduce eligibility for hip replacement surgery by 12% and knee replacement surgery by 19%, leading to savings of about £2.1 million per year.

A spokesman from the Royal College of Surgeons commented:

“While the clinical commissioning groups have stated they hope this policy will save them £2 million a year, it is unclear whether they have considered the costs of not treating a patient.

“This could include the cost of pain relief medication and a later operation when the patient does meet the required pain and weight thresholds. Delaying access to surgery also adversely affects a patient’s quality of life and surgical outcomes, meaning the operation may not be as beneficial as if it had been carried out earlier.”

Arthritis Research UK offers the following advice for people who have been denied joint replacement surgery:

• “Discuss with your consultant other treatment options, such as weight loss, physiotherapy and a pain management course or pain medication, to determine an alternative treatment plan;
• Ask for a second opinion;
• Explore what appeals process your clinical commissioning group has in place;
• Visit the arthritis and daily life section of our website here, which has self-help and exercise tips designed to help you manage your pain.”

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