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16 Mar 2020

Five things you need to know about hip replacement surgery

What should you find out before you have hip replacement surgery? We've asked an orthopaedic surgeon for his expert advice

If your GP has referred you for hip replacement surgery, as an NHS patient in England you have the choice of where to go and who to see. So if medication, physiotherapy or other methods aren't helping any more and you need an operation, here's what you need to know to get the best treatment.

If you're based in Northern Ireland, Scotland or Wales, you don't have a legal right to choose your provider under the NHS, but your GP can still involve you in decisions around your treatment.

As a private patient, you should have choice wherever you live, although you could be restricted by the approved list of providers your health insurer uses.

Our guide to the best private health insurance reveals the health insurers rated most highly by Which? members.

How to make the right hip replacement choice

It's important to highlight that, if you prefer not to get involved in choosing your surgeon or hospital, or aren't given the option, there's little evidence that this will have any bearing on your outcome. So don't feel obliged to wade through the reams of information that could be required to make your own informed decision.

Regulatory health bodies, such as the Care Quality Commission (CQC) and the audit data that is collected both by the NHS and privately, should be identifying hospitals or consultants performing relatively poorly, with appropriate action taken.

But if carrying out some research about your treatment makes you feel more in control, Matthew Porteous, orthopaedic surgeon and chair of the National Joint Registry Data Quality Committee, has the following expert advice.

1. Check the number of hip replacements a consultant has done

Look at the number of replacements a surgeon has done in the past 12 months. A Canadian study found that surgeons who had performed 35 or fewer hip replacement procedures a year were more likely to have a higher rate of dislocations, or patients who needed further hip surgery.

You should be able to find this information on one or more of:

If you're having hip revision surgery, the number of procedures is even more important. As it's a rarer procedure than standard hip replacement surgery, the total number of hip revisions that a surgeon does a year is likely to be far lower. But don't choose someone who has only done one or two.

2. Be wary of 'outlier' hospitals

A hospital that's an outlier is one that falls outside of the norm in terms of its performance records.

If it's an outlier because its hip replacement record is significantly better than average, this is obviously not something to worry about. However, if, for example, it's significantly worse than its peers for hip revision rates (the number of people who require repeat surgery), this should raise a warning flag.

Last year, there were six NHS hospital and four private hospitals that had worse than expected results. You shouldn't take these statistics on their own - there may be valid reasons for the relatively poorer performance - but ask for more information before agreeing to be treated at the hospital.

3. Your consultant may have useful, unpublished information

There will be data that consultants should have access to which isn't published online, such as complication rates adjusted for certain risk factors - such as age and other health conditions - and the number of each type of specific replacement they do. Ask for extra details related to your specific treatment and circumstances.

4. Ask your doctor what type of joint replacement they want to use

There are hundreds of possible hip replacement prostheses available, so don't worry about trying to research all the options yourself.

Ask your consultant what they have planned, then you can look it up on the Orthopaedic Data Evaluation Panel (ODEP).

Ideally, for a hip or knee replacement, look for a rating of 10A* or better; the number reflects the number of years of evidence.

You could also check the BMJ Open report. This publishes data of the failure rates of different prostheses at three, five, seven and 10 years, and may require a bit more deciphering.

If you have questions about your surgeon's choice, don't be afraid to ask them about it.

5. Look at surgical site infection rates

Wound infection data can be found on gov.uk. This data is only collected for orthopaedic surgery. Look for rates below 1%.

Find out more about patient choice and what you need to think about when deciding where to have non-urgent treatments.