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Post-operation physiotherapy following hip and knee replacement varies significantly across the UK according to new research by Dr Toby Smith, leading to a ‘postcode lottery’ for patients.

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Published in the journal Physiotherapy, the study found that patients are more likely to receive physiotherapy after hip or knee replacement in London and the North of England. Patients in the South West are the least likely to receive physiotherapy.

The first nationwide study of its kind also revealed that older male patients who have had hip and knee operations are less likely to be offered physiotherapy than other groups, while women were more likely to receive physiotherapy than others.

Lead researcher Dr Toby Smith, Senior Researcher in Rehabilitation at NDORMS said: "Generally we found that physiotherapy provision was greater following a knee replacement compared to a hip. In the first year after the operation, 79 per cent of people who had a knee replacement received at least one physiotherapy session compared to only 53 per cent of those who had a hip replacement.

"But we found that there is substantial variation in the provision of physiotherapy nationally. And this variation is not explained by the severity of a patient's physical impairment after their operation.

"We are concerned that some people who would really benefit from physiotherapy are slipping through the net, and not having as good an outcome as we would want."

Hip and knee replacements are two of the most common surgical procedures performed worldwide. More than 200,000 were carried out in England and Wales in 2017. The study looked at data collected from more than 37,000 patients in their first year after surgery. It examined the amount of physiotherapy received, and compared it to factors such as the patient's level of disability, geographical location, age, social deprivation, gender and ethnicity.

Post-operation physiotherapy is recommended for a minimum of six weeks. This can include hydrotherapy, resistance or aerobic exercise, and may be individual or group-based. But there is substantial variability in the delivery and content of physiotherapy across NHS trusts.

"We hope that organisations who aim for parity in service provision across the UK, such as NHS England, Nice and the Quality Care Commission, will act to correct the patient inequality we have shown," concluded Toby.

The research team studied data from the UK's National Joint Registry – the largest joint replacement registry in the world, and was a collaboration between the University of Oxford, the University of East Anglia, and the University of Bristol.

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