Inequality in access to Hip Surgery
Access to total hip replacement (THR) in the UK remains unequal, with significant variation linked to social and geographic factors. Despite the proven benefits of surgery in restoring mobility and independence, many patients continue to face barriers to care. Rigid referral thresholds for BMI, smoking status or HbA1c, alongside system-level risk aversion, often exclude those most in need. Patients from deprived or rural areas wait longer, face more cancellations, and are more likely to drop out of the pathway entirely.
These disparities reflect deeper social determinants of health, including income, education, ethnicity and housing, that influence both access and outcomes. When applied without nuance, surgical risk thresholds may inadvertently reinforce inequality. Patients with complex health or psychosocial needs, or those from ethnic minority backgrounds, are particularly vulnerable to being overlooked. Addressing these inequities requires cultural understanding, flexibility in decision-making, and system-level support for surgeons who manage higher-risk cases.
The BHS Culture and Diversity Committee is actively responding to these challenges. We are undertaking qualitative research exploring surgeons’ perspectives on the barriers to offering THR to patients considered “high risk,” with the goal of identifying practical and ethical solutions to improve access to care. We will also be raising awareness to the topic through two Topic in Focus sessions at the conference, highlighting inequality and the importance of equitable access to surgery. In addition, the committee are developing collaborations with national and community charities to engage underrepresented patient groups and promote early access to musculoskeletal health services. Whilst these steps alone will not solve the problem, we hope they will contribute, in a small but meaningful way, to creating fairer access to life-changing hip surgery for all patients.
Read more about this subject on the BOA website