Hip Hip Hooray! But maybe not today? (Two Hip Replacement Stories)

From the outset I want to state for the record that I am not a surgeon and I am not a doctor. I have been an orthopaedic medical rep for over 15 years and seen in excess of 6,000 orthopaedic procedures. My colleagues tell me that I am a geekas I find the science and technical nature of Orthopaedics fascinating.

I have been prompted to write this article after speaking to two village residents who have had what I can only describe as “sub-optimal” treatment from the NHS. I stress now, that this is not after the point of surgery but in the lead up to having their hip replaced!

Some people say that the NHS is broken. I say that the NHS is currently not in a good place and is still trying to recover from the effects of Covid.That said, when I started work in 2007 the “18 Week Pathway” was what everybody was striving to achieve - that there was a maximum of 18 weeks between referral and surgery. Locally, pre-Covid wait times were in the order of 50 weeks. And then it got worse, a lot worse.

The NHS waiting list peaked at 8 million. That means that eight million people were waiting for routine surgery. When there is this much pressure on an already struggling system things tend to change and not necessarily for the better.

The first patient I want to write about is someone I have known for years. Mrs X is young (50) and many would say too young for a hip replacement. Nobody wants a hip replacement; however, what they do want is to be free of pain and able to get on with their life. She followed the obvious pathway of speaking to her GP and after being referred to Connect Health, she was sent for physiotherapy. As I stated at the beginning, I am not a doctor, and I do not have super powers of x-ray sight. However, to me it was obvious - after months of physio and increasing pain medication - that the answer would only be found from a plain radiograph (x-ray). Finally, she was referred for an x-ray. Unfortunately, the person looking at the x-ray did not know how to interpret it! She was sent for more physio.

When Mrs X paid for a private consultation (on my recommendation) her surgeon took one look at the same x-ray and said, “You are bone on bone and need a hip replacement, sorry”. No amount of physio or alternative therapies offered by Connect Health (a partner with the NHS) are an option at this point. Yet until this point that was all that she was offered. Why?...

Mrs Y is a young 82 year old. Her hip pain is debilitating. She is house bound as a result. She had her other hip replaced 15 years ago. I was unaware of Mrs Y until a chance conversation with a fellow dog walker one morning. I passed on my number and said, “Please ask her to call me”. Thankfully she did. Like many of us Mrs Y believes in the NHS. It is a fantastic institution. However, as I said, it is severely struggling and as a result Mrs Y was simply left waiting for the call. “I struggle to walk at all. It’s only with the help of a stick or crutches that I can manage to move around the house. I’m constantly in severe pain and only feel slight relief when sitting upright in a hard chair…”

When she presented to her GP complaining of hip pain she was referred for physio! Why? If you’ve had to replace one tyre on your car why on earth would you think that you don’t need to replace the other side? It is this level of care that resulted in 15 months of agony and for what? (I will now climb down from my high horse - but it really does upset me.)

So why were both Mrs X and Mrs Y sent for physio? Neither would receive any benefit from it whatsoever, and it just offered a false hope and the thought, “at least they are doing something”. The sad fact of the matter is, that while they were undergoing physio they are not on the waiting list for surgery. Mrs X could not work and Mrs Y could not even leave her house unaccompanied. But neither is considered to be one of the eight million on the waiting lists! (Bob, get off the high horse, now!).

Aware of the long wait time, Mrs Y asked her GP “What are my options?”. The reply; “You either wait or pay”. Typically a THR (Total Hip Replacement) done privately will cost between £15,000 and £20,000 and not everybody can afford this. What the GP said is not true. In fact, it is WRONG!

Everybody in England is entitled to use the “NHS Choose and Book” system previously known as the “FCN” or Free Choice Network and also known as “NHS e-Referral Service”. I do not understand why GPs do not tell their patients about this option. Current wait times through NHS Choose and Book are between 6 and 10 weeks.

From Launton there are various private hospitals in close proximity. Both the Cherwell hospital in Banbury (formally the Ramsay Horton NHS Treatment Centre) and BMI The Chiltern Hospital in Great Missenden offer the Choose and Book option. You receive the same implant, put in by the same surgeon, at the same cost to the NHS as if the operation was performed in an NHS hospital. The only difference is the wait time.

Should you be in need of a Joint Replacement, there are options out there for you.

You do not have to “Wait or Pay” and most definitely do not have to “put up with the pain”.

At the time of this going to print Mrs X is back at work having used the Choose and Book pathway. Mrs Y is on her way to recovery having waited over 15 months. Both are happy for me to share their stories and neither was straightforward - but that is for another issue.

Bob Watmough