PATIENTS who need orthopaedic surgery including hip and knee replacements may not be able to undergo treatment if they are overweight or smoke if proposed criteria changes are approved.

The NHS Southend and NHS Castle Point and Rochford Clinical Commissioning groups are reviewing their policies in relation to orthopaedic care in the hope they can improve outcomes for patients after surgery.

Currently, all patients due to undergo surgery such as hip, joint or knee replacements have to meet a certain set of criteria but clinicians have raised concerns the criteria is not stringent enough.

The current criteria for hip and knee replacements mean patients will only be funded for the surgery if they complain of severe join pain and if other measures have been exhausted and failed.

The CCGs say that patients who undergo surgery despite having other health conditions – such as being obese with a BMI over 40 or if they smoke – may suffer poorer outcomes as a result.

Dr Brian Houston, Southend CCG Governing Body Member and clinical lead for Musculoskeletal Clinical Assessment (MSK) said: “We are potentially going to change our eligibility criteria for total hip replacements, simultaneous joint replacements, total knee replacements and arthroscopy.

“Surgery is not always completely successful if patients have not addressed other conditions which impact on their physical health.

“There is clear evidence that patients who have a BMI of 40+ or who smoke have poorer outcomes following hip and knee replacements.

“This is where we are looking to enhance the existing criteria and we want to hear views from local residents.”

Orthopaedics is one of the highest spend areas at Southend Hospital; for Southend patients alone there were 519 hip or knee operations were carried out in 2015/16 at a cost of £3,663,629 while in Castle Point and Rochford there were 698 operations, costing £4,931,284.

To undergo hip or knee replacements, proposed changes would see patients with a BMI of 40+, which is classed as obese, would be supported to lose weight while patients who smoke would be expected to quit smoking for at least eight weeks before their operations.

Patient must also be medically fit to be suitable for surgery meaning conditions including diabetes and hypertension must be assessed and the patient must not have suffered “significant cardiac events” or had a stoke within the last nine months.

It has also been proposed that simultaneous join replacements should not funded as, although it may be an advantage having the surgery all in one go, it may increase complications and recovery time.

Residents in Castle Point, Rochford and Southend are now being asked for their views on the proposed changes.

The consultation is open until Wednesday, September 21.

Find out more details about the consultation at and complete the survey at