Knee replacement surgery rates decreased following BMI policy introduction

Knee replacement surgery rates decreased following BMI policy introduction
© iStock/Stephane Noiret

New research highlights that when the NHS introduced body mass index policies, there was a decrease in knee replacement surgery rates.

In a National Institute for Health and Care Research (NIHR) funded study, researchers from the University of Bristol found that BMI policies decreased knee replacement surgery prevalence, which may lead to health inequalities. The researchers also suggest regions that introduced the policy changes have seen a decline in knee surgery.

The findings are published in PLOS ONE.

Changing access to knee replacement surgery

NHS clinical commissioning groups (CCGs) across England changed access to hip and knee placement surgery for patients who are overweight or obese. However, there are regional variations, with some locations having no such policy, whereas some regions reject patients based on their BMI.

To understand the impacts of such policies on knee replacement operations, the researchers analysed data from 481,55 patients between January 2009 and December 2019 from the National Joint Registry and compared regions with and without a BMI policy.

They investigated the effect of these commissioning policies on access to knee replacement surgery and possible health inequalities.

Postcode health inequalities in surgeries

The researchers found that the BMI policies affecting knee replacement surgery criteria have decreased the number of surgeries and could have led to postcode health inequalities.
The changing criteria could lead to deteriorating health inequalities, subsequently causing a rise in private knee replacement surgeries and a reduction in the most economically deprived patients receiving surgery. However, the researchers discovered that knee replacement operation rates fell amongst all patient groups, despite the policy targeting overweight or obese patients.

Dr Joanna McLaughlin, NIHR Doctoral Fellow in the Bristol Medical School: Translational Health Sciences (THS) and lead author of the study, said: “NHS policy on whether people can immediately access referral for knee replacement operations if they are overweight or obese varies depending on where you live in England.

“Our study raises the concern that these policies are linked with worsening health inequalities with fewer NHS operations for the least affluent groups in society when policies are introduced.”

The research team is now calling upon commissioners and policy decision-makers to reconsider restrictive policies that are contributing to the lack of surgeries. The researchers also suggest that the recent formation of Integrated Care Systems from existing CCG groups is an important opportunity for positive changes to a policy position.


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