Older, stoic patients suffering in silence with hip and knee operations falling behind


New Research shows the many millions the government's investing to fund more hip and knee replacements is struggling to keep pace with our growing, ageing population.

The Otago University study, published in today's New Zealand Medical Journal, shows despite six per cent more joint replacements being funded in the five years to 2013, the surgery rate nationwide actually dropped 0.6 per cent per head of population.

The current system puts people in certain parts of the country ahead of others for public funding.

Source: ONE News

"We've got a long-term problem ahead of us and at the moment we're not really making a great deal of progress," says study co-author and orthopaedic surgeon Dr David Gwynne-Jones.

"We should be doing more procedures based on our population but at the moment we're just barely standing still," he says.

The study also highlights inequity of access, with women, Maori, patients from lower socio-economic groups and patients at smaller DHB's actually faring better and getting their operations more successfully than patients at larger DHB's.

"In larger centres there are more complex cases and more patients requiring trauma surgery, forcing other surgery to possibly be delayed or cancelled," he says.

Canterbury DHB Orthopaedic surgeon Gary Hooper says getting surgery is one thing, but managing to access a first specialist assessment then being operated on within the government's four month surgical waiting list timeframe are often greater hurdles.

At the moment we're just barely standing still"
Dr David Gwynne-Jones

"In Canterbury over 50 per cent don't get an assessment for hip and knee procedures so those people miss out, they don't even get past 'go'," he says.

Arthritis NZ Chief Executive Sandra Kirby says the study highlights the fact many patients are older, stoic and don't kick up much fuss and that thousands are suffering in silence. She says the issue needs more attention and investment.

"We probably won't ever have enough surgery for osteoarthritis while we don't have arthritis as a health priority," she says.

Gary Hooper agrees. "There's not the same emotive aspect to a crippled old lady living alone with crutches who's just coping, compared to a child who's dying of cancer or a person who's dying of a cardiac problem," he says.

Mr Hooper says joint replacement is highly successful and cost-effective in getting people back to work to lead active lives, saving health funds in the long term.

The Health Ministry says joint replacement spending has risen significantly since the study period ended, with an extra forty-six million alone last year.

The Clinical Leader of Prioritisation at the Ministry, Dr Chris McEwan, says it's new Surgical Prioritisation Tool, which came into effect in July, will deliver more fairness and equity, with patients having a greater say.

"By being consistently applied it's going to give us a more reliable and fairer selection of patients for treatment," he says.

While acknowledging further financial investment will be needed, Dr McEwan also points to the Ministry's new Mobility Action Programme, aimed at preventing and prolonging joint deterioration as a means of helping patients avoid surgery by retaining fitness. 

"What we have to recognise now is that the population has a responsibility to look after their own health and welfare by staying mobile, by losing weight and by keeping well," he says.

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