By: 1 March 2009

The data was collected between September 2008 and February 2009 using a self completed questionnaire. Results from respondents stating they had not been diagnosed with either a hip or a knee problem were discounted from the data. This report sets out the key findings of the survey.

1. Age and Gender
62% of respondents were male and 38% were female. 56% of respondents were over 60, 27% between 51 and 60, and 12% between 41 and 50.

Given the perception of hip and knee replacements being for the elderly it is noteworthy that 44% of our respondents were under 60, considered relatively young in terms of hip and knee replacement ages.

“These findings are generally consistent with what I see in my surgery. Its become much more common to see relatively young people considering joint replacement surgery. As a result patient’s priorities are changing and post operative expectations are also rising.”

2. Activity Levels
52% of respondents considered themselves ‘quite active’ in comparison with people of their same age, about 18% were considered ‘very active’ and the remaining 30% considering themselves not very active.

The most common activity for respondents was walking, followed by gardening, cycling and swimming. 14% of respondents listed no activities.

At the other end of the scale over 5% of respondents listed skiing as a preferred activity.

3. Pain and Diagnosis
21% of people responding to the survey had been experiencing hip or knee pain for less than 12 months. 17% had experienced this pain between 1 and 2 years, 27% between 2 and 5 years, 11% between 5 and 8 years.

A surprising 22% of respondents had been suffering hip or knee pain in excess of 8 years. This result was significantly higher for knee patients than hip patients (5%)

“I found this result quite surprising. There is no need for such a high number of patients to wait over 8 years before resolving their joint pain. Most operations take place 18 weeks between referral and surgery. It would be interesting to understand the factors that are causing some people to wait so long.”

Approximately 52% of respondents had been diagnosed with a knee problem by their doctor and about 40% had been diagnosed with a knee problem. The remaining 8% were excluded from the remainder of the survey using our methodology.

3.1 Hip Patients
The majority of respondents assessed their hip pain as ‘moderate’ (49%) with 30% saying they had been troubled by pain ‘some nights’

A significant proportion of respondents assessed their hip pain as ‘severe’ (20%) for example 26% suffering from hip pain ‘every night’.

A large proportion of respondents were limping all of the time because of their hip pain (36%) and many more were limping most of the time (22%).

29% of people could walk for between 5 and 15 minutes without suffering severe pain and 24% of people couldn’t walk around the house or at all without suffering severe pain.

3.2 Knee Patients
Again the majority of respondents assessed their knee pain as ‘moderate’ (53%) with 26% reporting severe pain.

Knee respondents generally found more difficult with getting in and out of a car or using public transport (55% reported moderate difficulty) than they had with washing and drying themselves (33% moderate difficulty).

23% of knee respondents found difficulty with walking around the house or at all without suffering severe pain. 35% of people could walk for between 5 and 15 minutes without suffering severe pain.

19% of knee respondents were walking with a limp all of the time and 25% were limping most of the time.

3.3 Diagnosis
There are obvious limitations to a self completed survey when considering levels of pain. However these sections of our questionnaire closely follows scoring systems used by GP’s to assist with referring patients to an orthopaedic specialist. If the same scores had been recorded by a GP then it is likely that 66% of our respondents would have been referred to an orthopaedic specialist.

4. Factors When Considering Joint Replacement
When considering having a joint replacement 50% of people were looking to return to activities that they had done in the past, 26% were hoping to eliminate the pain they were experiencing and the remaining 24% were looking to prevent further deterioration of their joint.

In further questioning, the vast majority of respondents considered the reputation of their surgeon to be the most important factor in considering joint replacement (78%), with 14% considering the implant reputation most important and the remaining respondents stating that the hospital reputation was most important to them.

“I suspect if this question had been posed just 5 years ago then the Surgeon responses would have been even higher. Clearly the ability of a particular surgeon has a major impact on the success of the operation, however, more people are becoming aware of implant reputation and in particular as patients get relatively younger, the longevity of the implant product.” Mr Steve Young, Consultant Orthopaedic Surgeon

In terms of the operation 42.5% of respondents’ top priority was a pain free procedure. but for 31% the most important factor was access to the latest and best medical technology. 24% were concerned about fast recovery times but very few (2.5%) were concerned about the size of their incision.

Hip patients were less motivated by a pain free operation than knee patients and were more interested in access to the best medical technology.

5. Expected Outcomes
The most commonly expected outcome from joint replacement surgery was to return to previous activities and to be free from pain (75%), the most optimistic of the possible responses. A further 20% of respondents hoped to be free from pain but with restricted movement. Knee patients were generally much more optimistic than knee patients about the outcome of the surgery.

6. Conclusions
The 2009 survey has produced some interesting results that the support the anecdotal trends that our medical panel have reported. For example, patients undergoing this type of surgery are getting younger and that they place the greatest amount of emphasis on the ability of their surgeon. However, there were some more surprising results reported, such as the duration of time patients were living with this type of pain and that the availability of the best medical technology was becoming a key factor.