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Hip and Knee Replacement

Please click here to view the full Hip and Knee Replacement Commissioning Statement.

Commissioning Position

NHS Vale of York CCG does NOT routinely commission referral to secondary care for hip or knee replacement for patients whose BMI is 35 or above.

Exceptions to this threshold:

Please note: As part of the Prevention and Better Health strategy, patients with a BMI range of 30 to 35 will be covered by the Optimising Outcomes from All Elective Surgery Commissioning Statement  also note that any patient who is a current smoker will also be covered by this statement, regardless of their BMI.

Funding will ONLY be considered where criteria are met (see section 3). The clinician needs to ensure that the patient fulfils all the criteria and provides evidence of any of the clinical indications before they are referred to secondary care.

All other cases need to be referred for consideration by the Individual Funding request panel (IFR). For further information see IFR policies and guidance (including the referral form)

To submit an application to the CCG's Individual Funding Request Panel, please click here for further information.

In line with NICE CG177 Care and Management in Osteoarthritis3, patients should be offered advice on the following core treatments. (All conservative options should have been tried for at least 3 months).

  1. Non pharmacological management4
  1. Pharmacological management

Arthritic pain is chronic nociceptive pain and drug management is covered in the RSS pathway guidance for pain relief.

This includes:

At least three different types should be tried. Diclofenac and Cox2 inhibitors are not recommended because of the increased cardiovascular risk

  1. Before any referral for surgery, patients also have to meet the following criteria:





Patient Information

Further information for patients can be found the following link:


  1. Referring Clinician

Therefore the referring clinician must:

  1. The MSK service must refer all requests via the RSS and demonstrate that