A total hip replacement is the usual surgical treatment for a person with severe osteoarthritis of the hip. Wear and tear of the weight-bearing joints increases with age.
Pain, stiffness and immobility are the principal symptoms of wear-and-tear arthritis. The main indication for surgery would be uncontrollable pain and loss of independence as a result of decreasing mobility. The replacement of a hip joint is major surgery. The usual hospital stay is about 10 days, at which point the patient has been intensively mobilised and will be able to walk with the aid of sticks. Full mobility is restored with a continuing home exercise programme.
Northern Ireland:
June (72) lives with her husband in East Belfast. She had a right total hip replacement in 1997. In October 1998 she presented to her GP with problems in the left hip. June had pain which was worse in the morning and her movement was restricted. Her GP sent her for an X-ray which confirmed extensive osteoarthritis and she was referred back to the orthopaedic surgeon who had performed the surgery on her other hip. She was assessed in outpatients six months later, by which time the pain was keeping her awake at night despite maximum doses of painkillers.
During the year she was waiting for surgery, she began to use a stick and was unable to climb stairs. Eventually, she and her husband moved to sheltered, ground-floor accommodation because of her disability.
June's surgery went well; she had made a full recovery six weeks later and was delighted to be off "those constipating painkillers". She regained her mobility and according to her GP, her old "bounce" is back.
The Republic
Peter is a 61-year-old Dublin man who retired five years ago after a heart attack. He went to see his GP after a year of increasing pain in his left hip. An X-ray showed "moderate" osteoarthritis and he was prescribed anti-inflammatory drugs and physiotherapy. He also requested a referral to an orthopaedic surgeon.
Although Peter has a medical card, he opted for private treatment because of anticipated delays in being seen in the public hospital. He saw the orthopaedic specialist in late August 1998 and was advised to lose weight and carry out specific exercises.
Peter's symptoms settled until early 2000, when the pain level increased considerably. This stopped him walking for any distance, with the pain especially severe after activity.
He saw the specialist again on September 8th, 2000, who decided he was an urgent case because the level of pain was contributing to his angina.
Peter was admitted to Tallaght Hospital on November 9th, 2000, for a total hip replacement. This went well and he was discharged on November 24th and is now pain-free and fully mobilised.
Comparison:
Using the private system in the Republic meant a two-month wait for surgery, once the decision to operate was made. In the North, private hip replacement is available within weeks of referral, according to June's GP.
The delay in the NHS is contributed to by the wait for outpatient appointments. The orthopaedic waiting system does not distinguish between patients who are likely to need surgery for their condition and those with less severe conditions. June's GP is involved in an initiative to streamline the waiting lists, so that those in most need of surgery are seen first.
The fact that a medical-card patient in the Republic would opt for private treatment is not a surprise. When told of public waiting times, those who can afford it will usually opt for surgery in a private hospital. The implications of this for the true length of waiting lists needs to be explored.