NHS Lancashire and South Cumbria ICB regularly reviews its clinical policies to ensure they reflect the latest evidence-based guidance and best practice. This is a rolling programme and sometimes results in changes being made to the policies.
We are currently reviewing the Hip and knee replacement surgery in the over-16s policy and would welcome your views on the proposed changes.
Hip and knee replacements are common NHS operations. They replace a worn or damaged hip or knee joint with an artificial joint (a new “man‑made” part). This new joint is usually made from metal, plastic, or ceramic.
The operation is done to reduce severe pain and help people move better, often when the smooth covering in the joint has worn away. It is done in hospital, usually with a general anaesthetic (you are asleep). The operation often takes about 1 to 1.5 hours. Many people go home the same day or soon after. Getting fully better can take several months. The new joint is usually made to last about 15 to 25 years.
NHS Lancashire and South Cumbria ICB does not have a specific policy just for hip and knee replacement surgery and would like to bring it in line with other nearby ICBs, like Greater Manchester and Cheshire and Merseyside.
The new wording in full
Joint replacement (arthroplasty) surgery for hip or knee is routinely commissioned if all of the statements (1 - 4) are satisfied.
1. For each patient, all of the following criteria must be satisfied:-
· Patient’s symptoms (pain, stiffness, reduced function or progressive joint deformity) are having a substantial impact on their quality-of-life
· Symptoms persist despite at least a 3 months’ trial of conservative measures (such as analgesics, prescribed exercises)
· There is radiographic confirmation of diagnosis.
2. Patients are given advice on preoperative lifestyle modifications (e.g. exercise, weight management, diet and smoking cessation)
3. The decision to go ahead with surgery follows a shared decision-making process between the patient and clinician following a discussion regarding the alternatives, benefits & risks and provision of appropriate information.
4. Patient specific factors such as age, sex, smoking, overweight or obesity and comorbidities should not be barriers to referral. The impact of these on surgical outcome should be explained to the patient.
5. Patient specific instrumentation techniques are not routinely commissioned unless the case is complex, conventional instrumentation is unsuitable, and its use has been approved by a local or regional multidisciplinary team (MDT) for that individual.
6. Custom (patient specific) implants are not routinely commissioned unless the case is complex, and its use has been approved by a local or regional multidisciplinary team (MDT) for that individual.
Exclusions
1. Patients undergoing revision of a previous joint replacement are excluded from this commissioning statement.
2. Patients with previous surgery on the joint are excluded from this commissioning statement
3. Patients with rapidly progressing deterioration over a few weeks or have red flag warning signs for bony metastases* are excluded from this commissioning statement and require urgent referral.
4. Children and young adults under the age of 17 years are outside the remit of this commissioning statement.
* Red flag symptoms for cancer-related bone pain included severe progressive pain that is worse on movement or at night, inability to bear weight, signs of hypercalcaemia, and pain on direct palpation.