Arthritic patients should have their condition treated with pain relief or physiotherapy for at least three months before being considered for a hip or knee replacement, a series of new reports recommends.
Patients should also exhibit severe symptoms before they can be referred for hip or knee arthroplasty (replacement), the health technology assessments published by the Health Information and Quality Authority (Hiqa) state.
The reports say that all patients should have timely access to radiological investigations of their osteoarthritis via primary care services. X-rays should be carried out within three months.
The majority of patients with hip osteoarthritis should be managed conservatively in the first instance, according to Hiqa. This should be made available to patients in the primary care as soon as possible.
Options for conservative management of arthritis include pain relief, weight reduction and activity programmes, physiotherapy, adapted shoes and advice about “activities in daily living”.
The reports are the latest to be published by Hiqa in response to a request by the Health Service Executive to draw up agreed symptom thresholds for common medical procedures that patients would have to reach before being referred for treatment.
Hiqa director of health technology assessment Dr Mairin Ryan said the purpose of the reports was to ensure that the right patients were referred and treated at the right time and that “unnecessary referral” was avoided.
She said an aging population and increases in obesity and chronic disease were placing increasing pressure on the healthcare system. Demand for outpatient appointments and surgery continued to exceed available capacity.
“Fair and equal access to these surgeries as well as the needs and expectation of individual patients need to be balance with the requirement to maximise health gain for the population as a whole.”
