The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on minimally invasive total hip replacement.
It replaces the previous guidance on minimally invasive two-incision surgery for total hip replacement (NICE interventional procedure guidance 112, February 2005) and single mini-incision surgery for total hip replacement (NICE interventional procedure guidance 152, January 2006).
Hip replacement surgery using a minimally invasive approach may be an option for people with worn or damaged hip joints. This condition is usually due to degeneration of the joint (osteoarthritis), which can make walking painful.
The procedure replaces the damaged hip joint (the top part of the upper leg bone and the socket in the hip bone that it fits into) with an artificial one. In order to undertake the surgery through small incisions without muscle damage, specially designed equipment is used to support the leg and pull back the surrounding tissues so the surgeon can see the joint. X-rays are sometimes used to check the position of the bones and the artificial joint.
A code from one of the following OPCS-4 categories is assigned with the fourth character depending on the type of replacement procedure performed:
W37.- Total prosthetic replacement of hip joint using cement
W38.- Total prosthetic replacement of hip joint not using cement
W39.- Other total prosthetic replacement of hip joint
W93.- Hybrid prosthetic replacement of hip joint using cemented acetabular component
W94.- Hybrid prosthetic replacement of hip joint using cemented femoral component
W95.- Hybrid prosthetic replacement of hip joint using cement
Note: It is not possible to capture the fact that a minimally invasive approach has been performed using OPCS-4 codes.
The OPCS-4 code Y53.4 Approach to organ under fluoroscopic control can be assigned in addition if fluoroscopic guidance is utilised.
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.