Prognosis and duration of disabling effects

Any person with mobility restricted to a degree that they are VUTW will have seen their GP and will have been offered referral to a consultant well before they get to this stage of immobility. A consultant would offer hip or knee replacement surgery well in advance of this level of restricted mobility unless there is a contraindication or the person refuses surgery. If there is no consultant involvement and claimed needs are consistent with entitlement, the DM should investigate the reasons for non referral to a consultant and whether there is a prospect of joint replacement surgery. If such reasons cannot be found, it must cast doubt on the situation and possibly Departmental Medical Services advice should be sought.

+In cases where there is another medical condition preventing surgery, the duration should be based on that condition or the reasons for refusal for treatment. If there is absolutely no prospect of joint replacement surgery then as OA is a degenerative progressive disease and surgery is the only way of improving function, an indefinite duration is appropriate.

*Possible/potential joint surgery means joint surgery that has been discussed by the consultant with the customer and, which the customer has been advised will or is strongly expected to take place in the foreseeable short-term future (e.g. 6-12 months). It does not mean surgery that the consultant has loosely alluded to the customer needing or may need at some, as yet undetermined point in the future.

This distinction must be established by the Decision Maker.

It should be noted that generally, the outcome of joint replacement surgery in the lower limbs is very successful. Following surgery, rehabilitation and return to a reasonable level of activity can be expected within 2 months in the absence of complications. The elderly and frail and those with other significant medical problems may take longer to regain function but most should make a good recovery within 3 months even if the hip or knee replacement is bilateral.

Toe surgery is usually fusion of the joint, ‘fixing’ it in the optimal position for function, which should make the joint pain free. Again, rehabilitation and return to a reasonable level of activity can be expected within 2 months in the absence of complications.

Surgery for joint replacement in the upper limbs for OA is rare and the success more limited than for hips/knees but in the absence of complications better function should be obtained in 3 months.

If surgery is planned but the exact date is not known a maximum award period of 2 years is suggested to take account of the national variation in waiting times and the anticipated rehabilitation period. If a date of surgery is known, or the customer has been on the waiting list for some months, a shorter award period should be considered based on the individual circumstances of the case.

*In AA cases, bear in mind that no ‘Prospective Test’ needs to be considered and also the length of the award period in relation to the following renewal claim.

*Careful consideration should therefore be given as to whether the ‘Prospective Test’ is likely to be satisfied.

All information must be taken into account when considering the duration of award and the duration of award must be based on the particular circumstances of the individual claimant.

Amended April 2011