The introduction of weight and BMI limits on patients needing a National Health Service knee replacement has led to a reduction in surgery in England and could be contributing to a health postcode lottery, according to a study.
Researchers at the University of Bristol suggest that the NHS commissioning groups which have introduced restrictions for access to knee replacement surgery based on a patient’s weight or body mass index (BMI) have seen a decline in surgery.
The study said that with one in 10 people likely to need a knee replacement, many thousands of patients are directly affected by these policies.
The rules have been bought in over the last decade but there are a lot of regional differences.
Our study raises the concern that these policies are linked with worsening health inequalities— Dr Joanna McLaughlin, lead author
The research team analysed the rates of knee replacement surgery of 481,555 patients between January 2009 and December 2019 using data from the National Joint Registry and compared regions with and without a BMI policy.
They found that linking access to knee replacements based on a patient’s weight or BMI led to a decrease in surgery and potentially postcode health inequalities.
The research team is urging commissioners and policy decision-makers to reconsider restrictive policies that affect access to elective surgery as a matter of urgency.
Lead author Dr Joanna McLaughlin, from the University of Bristol, said: “NHS policy on whether people can immediately access referral for knee replacement surgery 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.”
An NHS spokesman said: “Patients and clinicians work together prior to surgery to optimise the chance of getting the best outcome and in some cases, losing weight prior to surgery reduces risk to patients and improves the chances of success for the procedure.
“The NHS is focused on reducing waiting times for knee replacements and overall, since the elective recovery plan was published in February, the number of people waiting more than two years for treatment has dropped by two-thirds.”
The study is published in the journal PLOS One.
