• Louise Linsell, Jill Dawson, Krina Zondervan, Peter Rose, Andrew Carr, Tony Randall, and Ray Fitzpatrick.
• Division of Public Health and Primary Health Care, Oxford University, Old Road, Oxford OX3 7LF, UK. louise.linsell@public-health.oxford.ac.uk
• Br J Gen Pract. 2005 Mar 1; 55 (512): 192-8.

BackgroundKnee pain is nearly twice as prevalent as hip pain in elderly people, yet knee replacement is far less common than hip replacement.AimTo investigate whether systematic differences in the primary care management of hip versus knee problems might explain the disparate rates of joint replacement.Design Of StudyCross-sectional, population-based postal survey.SettingRandom sample of 5500 Oxfordshire residents aged 65 years and above.MethodScreening questions were used to identify symptomatic individuals: "During the past 12 months, have you had pain in or around either of your hips/knees on most days for 1 month or longer?". Standard (Lequesne) severity ratings were obtained for each hip and knee. Logistic regression was used to estimate odds ratios (ORs) for "knee cases" versus "hip cases" for selected healthcare services and attitudes toward replacement.ResultsAmong 3341 responders, 212 hip cases and 612 knee cases were identified. Knee pain led to a GP consultation more often than hip pain (OR = 1.76, P = 0.04), but specialist referral was no more likely (OR = 0.85, P = 0.57). Similar percentages of hip and knee cases would agree to hip/knee replacement surgery if it was offered, but hip and knee cases differed in their views on the general success of joint replacement.ConclusionsSome variations in primary care management for hip versus knee pain were apparent. People with hip pain were mostly positive about replacement outcomes, whereas people with knee pain were more uncertain about replacement. Attitudes appeared to be influenced by knowing someone who had undergone such surgery.

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