title: Prospective study of elderly people comparing treatments following first primary care consultation for a symptomatic hip or knee.
abstract: BACKGROUND
  Symptomatic knee problems in elderly people are considerably more common than hip problems, yet far more hips are replaced.
  
  
  OBJECTIVE
  The purpose of this study was to investigate whether systematic differences occur in early primary care management of elderly patients who first consult with hip versus knee symptoms.
  
  
  METHODS
  A prospective analysis was carried out of anonymized records in the MediPlus general practice database. This was a 3 year (1996-1998) prospective study of 310,843 patients aged 65+ regarding consultations about a new hip or knee problem. Survival analysis techniques were used to analyse time to and frequency of various interventions.
  
  
  RESULTS
  A total of 1410 new hip and 3152 new knee consulters were identified. Baseline characteristics of the two groups were very similar. By 3 years following the first consultation, more of the hip cases had referral to a specialist (38.2% hips versus 31.5% knees, P <0.001) and joint replacement (9.6% hips versus 1.8% knees, P <0.001) recorded. Non-steroidal anti-inflammatory drug (NSAID) prescribing was high for both groups, with approximately 51% prescribed one of the safer forms and approximately 15% prescribed one with a lower safety record within 3 years.
  
  
  CONCLUSIONS
  Rates of specialist referral and joint replacement in older people are much lower, or slower, for those with symptomatic knees relative to hips. In the absence of surgery, prescriptions for pain killers are similar for both groups. Elderly people with symptomatic knees are therefore at increased risk of drug side effects relative to those with symptomatic hips. This may represent another facet of unmet need for surgery in people with knee disease.
authors.affiliation: Division of Public Health and Primary Health Care, Oxford OX3 7LD, UK.
authors.forename: Louise
authors.initials: L
authors.lastname: Linsell
authors.forename: Jill
authors.initials: J
authors.lastname: Dawson
authors.forename: Krina
authors.initials: K
authors.lastname: Zondervan
authors.forename: Tony
authors.initials: T
authors.lastname: Randall
authors.forename: Peter
authors.initials: P
authors.lastname: Rose
authors.forename: Andrew
authors.initials: A
authors.lastname: Carr
authors.forename: Ray
authors.initials: R
authors.lastname: Fitzpatrick
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D005194:Family Practice; D005853:Geriatrics; D006615:Hip; D006801:Humans; D007592:Joint Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D007717:Knee; D016347:Medical Records Systems, Computerized; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D011446:Prospective Studies; D011859:Radiography; D012017:Referral and Consultation; D016019:Survival Analysis
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal