Primary total hip replacement: variations in patient management in Oxford & Anglia, Trent, Yorkshire & Northern 'regions'.
OBJECTIVE
To examine national practice, and variations in practice, concerning total hip replacement; in particular the choice of prosthesis and the involvement of consultants in NHS operations.


METHODS
Pre-operative survey of patients undergoing total hip replacement.


METHODS
Five English regions serving combined population of 16.8 million people.


METHODS
13,343 total hip replacement operations in one year commencing September 1996, either in NHS or private sector.


METHODS
Prosthesis used for surgery, status of surgeons involved in operation, use of laminar flow operating theatre.


RESULTS
Prostheses without well documented 5-year survival were used in 5504 (58%) of 9417 operations for which information was available. The consultant was the operator in 4810 (64%) of 7499 NHS operations. In 1352 trainee-led operations, the consultant was present for only 637 (47%); this figure was 54% for trainees in years 1-4 of their training. Substantial variation between NHS consultant firms occurred both for use of prostheses with well documented survival data, and supervision of trainees by the consultant.


CONCLUSIONS
This large study is the first attempt to describe national practice for primary total hip replacement. Substantial variation among consultant firms was observed for all indices of practice reported.
Morris
R W
RW
Department of Primary Care and Population Sciences, Royal Free and University College Medical School, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK. rmorris@pcps.ucl.ac.uk
Fitzpatrick
R
R
Hajat
S
S
Reeves
B C
BC
Murray
D W
DW
Hannen
D
D
Rigge
M
M
Williams
O
O
Gregg
P J
PJ
D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D002983:Clinical Competence; D003253:Consultants / Q000706:statistics & numerical data; D003657:Decision Making; D004739:England; D005260:Female; D019538:Health Care Surveys; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital / Q000706:statistics & numerical data; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D013927:Thrombosis / Q000517:prevention & control