Researchers at The Royal Orthopaedic Hospital NHS Foundation Trust in Birmingham reviewed the patient reported outcome measures (PROMs) from patients who had undergone either primary or revision hip and knee arthroplasty over a ten year period from October 2012 to September 2022.
The study found that while patients recorded significant improvements in pain and quality of life after surgery, the starting position for patients from socially deprived or ethnic minority background was much lower meaning any improvements due to surgery were not enough to ‘catch-up’.
Mr Yuvraj Agrawal, Consultant Orthopaedic Surgeon, explains: “In patients from the most deprived areas, ethnic minorities and in those who English is not their first language, we see lower preoperative scores related to pain, mobility, activity levels and quality of life. While there could be several reasons why this is the case, patients report statistically significant improvements, identical to the other patient groups. This confirms that although the objective of surgery is achieved, the postoperative scores remain lower than the scores for patients from less deprived and Caucasian patients.”
The reasons for the observed differences are multi-factorial. On review of the published studies exploring data in other countries with different healthcare systems and in other specialties, we believe the challenges are identical. This is despite the health service in the UK being free at the point of contact via the National Health Service. Patients from high levels of social deprivation demonstrated difficulties such as poor awareness or understanding of healthcare processes, difficulty accessing healthcare, delaying treatment due to financial pressures and the need to continue working. Similar challenges are experienced by those from ethnic minorities, and those who spoke a first language other than English.
Mr Agrawal continues: “The study is a first of its kind comparing PROMs among different groups of patients undergoing hip and knee replacements. The data proves healthcare inequality exists among these patients, despite the substantial benefit these procedures can provide to patients, irrespective of social deprivation, ethnicity or first language.”
Facilitating easier access to orthopaedic and physiotherapy services with outreach into areas of social deprivation, and into ethnic minority communities may help support earlier intervention and better outcomes. Mr Agrawal adds: “Pathway changes are essential if we want to start closing this gap. Ultimately, if we can identify and treat patients earlier, and importantly before their PROMs drop below the levels seen in patients from less social deprivation, we may be able to ensure all patients achieve the same excellent results provided by hip or knee replacement surgery.”
