Half of all hip replacement operations are done by surgeons who do fewer than one such procedure a week, often with prostheses without a proved track record, says a parliamentary report.
Figure 1.
No list of approved hip prostheses exists
Credit: EAMONN McNULTY/SPL
Over 43 000 hip replacement operations are done in England every year. But with no list of which devices of the 64 available are approved, and with little monitoring of the results of different surgeons, patients may not be getting the best service, says the Public Accounts Committee.
It reports that despite guidance by the National Institute for Clinical Excellence in April 2000 on standards for hip prostheses to be used in the NHS, the Purchasing and Supply Agency has still not drawn up a list of devices that meet these criteria.
Although many surgeons are following the standards, 11% of consultants still use prostheses for which there is no published evidence of their effectiveness, says the committee.
Another worrying aspect of hip surgery is the fact that, owing to incentives from manufacturers, nearly half of all hospitals are using prostheses they would otherwise not purchase, says a report. In addition, 10% of consultants have accepted incentives from manufacturers of hip prosthesis, and in two thirds of cases the offers, usually of travel and training, are not properly recorded or appropriately approved.
The report also warns that the future of the National Joint Registry, set up in April 2003 to monitor the performance of joint implants, may be in jeopardy.
After six months the registry has records on only half the hip and knee replacements done in the NHS, but it needs information from nearly all consultants and trusts to be of value. If compliance with the registry does not improve, the registry will be unable to answer how the volume of a surgeon's work affects clinical outcomes in patients, says the report.
Hip Replacements: An Update can be seen at www.parliament.uk/parliamentary_committees/committee_of_public_accounts.cfm