Hip fractures are a common cause of hospitalisation, typically caused by falls particularly among older people who have lost skeletal strength due to osteoporosis. In nearly all instances following a hip fracture, surgical intervention is required to repair or replace the hip joint. There is general agreement that early surgical intervention improves patient outcomes and minimises the risk of complications. For this reason, surgery should occur within two days (48 hours) of hospitalisation. Some national guidelines stipulate an even more rapid intervention.
Time to surgery is influenced by many factors, including hospitals’ surgical and staffing capacity and inter-hospital flow and access. According to the most recent data, nearly three out of four patients aged 65 and over on average across EU countries underwent surgery within two days following admission with a hip fracture (Figure 6.17). In Norway and the Netherlands, the proportion of patients operated within two days reached more than 95%. By contrast, less than half of patients aged 65 and over were operated within two days following their admission for a hip fracture in Latvia and Portugal, although this proportion increased between 2019 and 2021.
Osteoarthritis is a growing cause of disability in Europe due to population ageing and the growing prevalence of obesity. It often requires hip or knee joint replacement surgery if symptoms persist after exhausting non-surgical management such as physical therapy and weight loss. Patient-reported outcome measures (PROMs), reported directly by the patient without interpretation by a clinician or anyone else, can be used to measure the quality of care by assessing outcomes from the patient’s perspective. Condition-specific PROMs, such as the Oxford Hip/Knee Score measures for joint replacement surgery, assess aspects specific to the condition, while generic tools such as EQ-5D assess general aspects of health that are not specific to a particular disease (Kendir et al., 2022[1]).
Figure 6.18 shows pre‑operative and post-operative scores on the Oxford Hip/Knee Score reported by patients who have received an elective hip (left) and knee (right) replacement surgery for osteoarthritis. The post-operative scores varied from 44 points in Finland to 39 points in Italy on the 48‑point scale on the Oxford Hip Score. The improvement before and after the hip replacement surgery ranged from 25 points in Ireland to 19 points in the Netherlands and Italy. The post-operative scores following knee replacement surgery ranged from 41 points in Finland to 35 points in Italy also on the 48‑point scale on the Oxford Knee Score. The average gain in patient-reported scores were slightly lower after knee replacement surgery compared to hip replacement surgery, ranging from 19 points in Ireland to 15 points in the Netherlands and Germany.
Figure 6.19 shows pre‑operative and post-operative scores on EQ-5D scale reported by patients who have received a hip replacement surgery (left) and knee replacement surgery (right). The post-operative scores after hip replacement surgery varied from 0.89 in Germany to 0.78 in Switzerland on the 1‑point scale on EQ-5D. The average change between pre‑operative and post-operative scores ranged from 0.50 points in Ireland and the United Kingdom to 0.14 points in Switzerland. The post-operative scores after knee replacement surgery were between 0.83 in the Netherlands and 0.76 in Switzerland, with an average gain in score ranging from 0.34 in the United Kingdom to 0.13 in Switzerland.
