Urban-rural differences in total hip replacements: the next stage

Area of Science:

• Orthopedic surgery
• Public health policy
• Health services research

Background:

• Investigating disparities in primary elective total hip replacement (THR) incidence across urban and rural communities in Northern Ireland.
• Analyzing age and sex-specific incidence rates to understand demographic variations in THR.
• Examining the need for an equitable system to allocate surgical capacity based on referral patterns and contracted capacity.

Purpose of the Study:

• To explore variations in primary elective total hip replacement incidence.
• To develop an equitable method for allocating surgical capacity.
• To inform commissioning practices for orthopedic services.

Main Methods:

• Retrospective review of 4,147 primary elective total hip replacement cases (1994-1997).
• Calculation of incidence rates using direct standardization.
• Application of age, sex, urban, and rural specific rates to general practice populations to estimate expected THR numbers.

Main Results:

• Overall age and sex-standardized incidence of primary elective THR was 87.6 per 100,000 population.
• Significantly higher incidence in rural (101.3/100,000) versus urban (77.6/100,000) populations (p < 0.001).
• Standardized male to female ratio was 1:1 overall, with variations in urban (1:1.2) and rural (1:0.9) areas.

Conclusions:

• Developed a system for calculating expected total hip replacement need based on general practice demography and rurality.
• Instituted a commissioning method to equitably allocate surgical capacity.
• Potential to significantly reduce in-patient waiting lists for total hip replacement.