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Primary total hip replacement: variations in patient management in Oxford & Anglia, Trent, Yorkshire & Northern
R W Morris1, R Fitzpatrick, S Hajat
1Department of Primary Care and Population Sciences, Royal Free and University College Medical School, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK. rmorris@pcps.ucl.ac.uk
Objectives:
To examine national practice, and variations in practice, concerning total hip replacement; in particular the choice of prosthesis and the involvement of consultants in NHS operations.
Design:
Pre-operative survey of patients undergoing total hip replacement.
Setting:
Five English regions serving combined population of 16.8 million people.
Subjects:
13,343 total hip replacement operations in one year commencing September 1996, either in NHS or private sector.
Main Outcome Measures:
Prosthesis used for surgery, status of surgeons involved in operation, use of laminar flow operating theatre.
Results:
Prostheses without well documented 5-year survival were used in 5504 (58%) of 9417 operations for which information was available. The consultant was the operator in 4810 (64%) of 7499 NHS operations. In 1352 trainee-led operations, the consultant was present for only 637 (47%); this figure was 54% for trainees in years 1-4 of their training. Substantial variation between NHS consultant firms occurred both for use of prostheses with well documented survival data, and supervision of trainees by the consultant.
Conclusions:
This large study is the first attempt to describe national practice for primary total hip replacement. Substantial variation among consultant firms was observed for all indices of practice reported.