Hip and knee replacement operations set to double
26 May 2004
Budget 2004 Hip and knee replacement operations set to double
The Labour-Progressive government is aiming to double the number of major hip and knee replacement operations being funded by the public health system within the next four years.
Prime Minister Helen Clark and Health Minister Annette King announced today that over the next four years the number of major orthopaedic operations performed each year is projected to increase from the current 4665 operations to over 9300.
In 2004-05 the project will cost $30 million and will lead to an additional 1890 operations. The project’s annual cost will increase to $70 million by 2007-08, when the number of major joint operations performed will be twice the current level.
Helen Clark said the increase in the number of operations will bring huge relief to thousands of New Zealanders in pain.
“Major joint replacements are the only treatment option for patients with high levels of immobility and crippling pain. These operations dramatically improve the quality of life by relieving pain and restoring independence.
“This project will ultimately enable over 9300 New Zealanders each year to regain their physical independence.”
Annette King said the doubling of the number of major orthopaedic operations will build on the government’s commitment to providing fair access to strong public health services.
“The project will also help some people get back to work. People in need of hip or knee replacements are often severely limited in their ability to work or live a normal life because of the pain and disability they suffer.
“The project also recognises New Zealand’s ageing population, and the lifestyle benefits resulting from people being able to continue taking an active part in society.
“Longer-term, preventive measures, like better diet and more exercise, will help reduce the impact of major joint disease, but they won’t help those people who require major joint replacements now.
“As part of an integrated package, the government is also funding several initiatives to improve the provision of orthopaedic services in public hospitals: The government will provide a number of nursing scholarships to each District Health Board. These scholarships will enable orthopaedic nurses to further expand their range of skills and expertise. The government will fund staff placements within each District Health Board to improve the management and prioritising of patients needing treatment. The New Zealand Orthopaedic Association’s Joint Register is one of the most comprehensive in the world. It collects information about the outcome of each operation. The government is contributing funding for their register.
“I would like to thank the Orthopaedic Association for its help in drawing the project together. This is an ongoing project. Progressive implementation of funding over four years means District Health Boards can plan properly for the increase in the number of operations performed,” Annette King said.
Bone and joint disease is common in New Zealand, especially in older people. A recent Colmar-Brunton research paper, conducted for Arthritis New Zealand, showed that nearly half of those surveyed have at least one family member with arthritis. Half of those surveyed aged over 60 said they personally had arthritis or a related condition, and by 65, more than half the population has X-ray evidence of osteoarthritis in at least one joint.
In the United States, health authorities predict one in every ten Americans will be affected by osteoarthritis by 2020, making it the most frequent cause of disability in that country.
New Zealand’s population is ageing, and the need for hip and knee replacements will continue to increase. Health and disability services for older people need to support ageing “in place” (offering people the chance to continue to live safely in their community). Constant pain – and enforced inactivity because of it – can severely affect emotional wellbeing, and a lack of physical exercise is also linked to cardiovascular disease, diabetes and obesity.
Sixty per cent of primary major joint replacements are currently funded through the public sector. While the number of operations performed each year is about 4650, the overall intervention rate (number per 1000 of population) for total hip and knee replacements has been significantly lower than in comparable countries.
The average intervention rate in New Zealand (in the public sector) for major joint replacements is 1.2 per 1000 people. This compares to rates of 1.9 in Australia, 2.3 in the United Kingdom and 2.6 in Sweden.
For a variety of reasons, delayed surgery for major joint replacements incurs costs to society which may exceed the cost of surgery. The elective services booking system now means we have better information about people waiting to see a specialist and the condition of those for whom treatment is clinically indicated.
The improved mobility associated with major joint replacements is well documented. Hip and knee replacement operations are universally accepted as the most effective treatment for advanced osteoarthritis of the hip and knee joints. This intervention ranks very highly on the international Quality Adjusted Life Years (QALYs) scale, a measure of the relative value of various health or social interventions. The ranking is substantially higher than that for coronary artery bypass surgery or renal transplantation.