Hip and knee replacement

For the treatment of

Hip and Knee intraarticular pathology in patients aged over 16

Commissioning position

This intervention is commissioned if:

joint symptoms (such as pain, stiffness, reduced function or progressive joint deformity) are substantially impacting quality of life AND
non-surgical management (therapeutic exercise, weight loss, pain relief) has been tried for up to 3 months and is ineffective OR is unsuitable to try AND
local pathways are used for referral

This policy excludes Hip/ knee replacements required due to acute trauma or cancer.

Summary of rationale

People should be counselled that age, sex or gender, smoking, comorbidities or overweight or obesity, based on measurements such as body mass index (BMI) can affect the risks of replacement surgery but should not be excluded from consideration for joint replacement because of these factors.

Osteoarthritis may not be progressive, and most patients will not need surgery, with their symptoms adequately controlled by non-surgical measures as outlined by NICE. When patient’s symptoms are not controlled by up to 3 months of non-operative treatment they become candidates for assessment for joint surgery. A decision to have joint surgery should account for pre-operative levels of symptoms, capacity to benefit, expectation of the outcome and attitude to the risks involved, as well as any personal preferences.

A patient decision support tool may help some people.