Rates of knee operation vary massively in the world’s wealthiest countries, a conference heard yesterday.
In the UK and Scandinavia the proportion of people having replacements is as much as four times that in New Zealand, Australia and Canada, orthopaedic surgeons heard.
There are also major variations in the way in which procedures are performed, the conference of the European Federation of National Associations of Orthopaedics and Traumatology heard.
In Denmark 72% of total knee replacement procedures involve replacement of the cartilage on the back of the knee cap – while in Norway this is done in just 2% of cases, researchers found.
And the use of cement varies widely between neighbours Australia and New Zealand, researchers found – with cement used solely in 90% of New Zealand operations but just 54% of Australian operations.
Researcher Dr Patrick Sadoghi, of Graz University Hospital for Orthopaedics and Orthopaedic Surgery, Austria, said the funding of healthcare systems might account for some of the differences – with some countries encouraging patients to delay the operation as long as possible.
Dr Sadoghi told the conference in Istanbul, Turkey: "Psychological strain varies from country to country, as does life expectancy and even the demands people place on their musculoskeletal system.
"The respective age distribution is another important factor. It can cause the additional financial burden to rise to such an extent that the indication for the surgical procedure is handled differently and quite a bit more restrictively if resources are scarce.”
* British researchers reported a study of factors contributing to deaths after hip fracture.
One is the time is takes to get a patient into surgery and the other is the patient’s mobility before an operation, researchers said.
The problem is thought to cost the British government about £2 billion a year for dealing with 70,000 injuries.
Mr Manjunath Ramappa, of the Northumbria NHS Healthcare Foundation Trust, UK, said: “Certain population characteristics have been constantly changing in the UK, such as average body mass index and average life expectancy which have been increasing.
"These factors have a tendency to decrease overall pre-fracture mobility. This could have led to pre-fracture mobility now becoming a significant pre-operative predictor of mortality.
"We think these factors are applicable across Europe as well.”
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