• Julian Dutka, Lukasz Dutka, Mateusz Janiszewski, and Grzegorz Hajduk.
• Department of Orthopaedic Surgery and Traumatology, Stefan Zeromski Specialised Hospital, Kraków, Poland, jdorttra@interia.pl.
• Ortop Traumatol Rehabil. 2008 Nov 1; 10 (6): 537-46.

IntroductionHip osteoarthritis (OA) is one of the most common causes of pain, physical disability and marked impairment of patients' physical fitness and mobility. Insufficient funding for health care contributes to prolonged waiting times for total hip replacement (THR) surgery, which has been proven to be the only effective treatment for OA. Average waiting time in Poland is estimated at 2-2.5 years. Objective. To carry out a retrospective comparative analysis of the cost of THR surgery vs. conservative treatment for OA in a variety of sociomedical aspects while patients are awaiting THR.Material And MethodsTwo groups of patients were compared. Group I consisted of 77 patients awaiting THR and treated with physical therapy and drugs. Group II consisted of 91 patients who underwent THR. Evaluations and comparisons were based on a modified WOMAC index, the SF-8 survey and estimates of pharmacological, procedural and orthopaedic equipment expenditures.ResultsProlonged waiting times and the associated conservative treatment costs, including drugs, physical therapy, sanatorium, orthopaedic equipment, transport, sickness benefits and costs of pharmacological treatment of complications, were shown to be approximately twice higher compared to the cost of surgical treatment. Apart from financial costs, other significant aspects should also be noted, such as deterioration of the patient's life quality and psychosocial health, and prolonged anguish.ConclusionsPharmacological treatment, rehabilitation, physical therapy and other methods appear to be inefficient in patients with hip OA awaiting THR and their costs are twice as high. Additionally, NSAID drugs produce GI ulcers in 25% of the patients. Psychosocial problems are also common for these patients. Surgical treatment produces a radical improvement of the quality of life and ameliorates psychosocial problems. Therefore, hip OA costs can only be reduced by shorter waiting times, which can be accomplished through an increase in funding resulting in wider access to the procedure.

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