1. Joint replacement: Which joints and when?

2. Joint replacement: Which joints and when? Paul Dieppe Ex-rheumatologist and health services researcher (no longer Bristol)

6. When should you consider having a joint replacement?

12. The pathway to joint replacement and how decisions are made

13. People in the Community The GP Orthopaedic Surgeon Surgery

14. People in the Community The GP Orthopaedic Surgeon Surgery Don’t seek help Give up seeking help

24. People in the Community The GP Orthopaedic Surgeon Surgery ?

27. So - when should you consider having a joint replacement?

34. So how can we make the system better and ‘fairer’?

37. CAPACITY TO BENEFIT (Likely gain -v- likely risk) DISEASE INTERVENTION Risk of the disease (do nothing?) How serious the case (pt circumstances) Likely gain (demographics, Co-morbidity) Alternatives (consequences)

38. 2) Local appropriateness criteria

41. Thank You