Hip surgery policies based on weight ‘worsen health inequality’, study warns

A study by the University of Bristol said rules put in place by NHS clinical commissioning groups (CCGs) across England more than a decade ago are “inappropriate and worsening health inequalities”.

Researchers looked at the rates of hip replacement surgery in 480,363 patients between January 2009 and December 2019 using figures from the National Joint Registry.

The regional data was then compared to areas with and without a body mass index score (BMI) policy in place.

They found that regional differences in rules meant some areas have no policy in place, while in others patients are denied access to hip replacements until their BMI is below a certain level.

The study was conducted before the NHS moved from CCGs to integrated care systems (ICS) in 2022, but researchers said there were still “geographical variations” in policies.

Dr Joanna McLaughlin, a doctoral research fellow at Bristol Medical School and lead author of the study, said: “NHS policy on whether people can immediately access referral for hip replacement surgery if they are overweight or obese varies depends on where you live in England.

“Nice (The National Institute for Health and Care Excellence) guidance on arthritis was updated in October 2022, and it clearly states that BMI should not be used to exclude people from referral to surgery, but restrictive policies are still in use in some regions.

“Both this current study, and our study on knee replacements published last June, show these policies have concerning associations with a sharp drop in the rate of joint replacements, worsening symptom scores, and worsening health inequalities.”

The research team urged commissioners and decision makers to “reconsider restrictive policies”.

They added the move from CCGs to ICGs “is an important opportunity for positive changes” in the NHS.

The study, published in BMC Medicine, was funded by the National Institute for Health and Care Research (NIHR).