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+<h1>About Dataset</h1>
+
+<p><strong>Data licence:</strong> Open Government Licence v3.0. <a href="#">link</a></p>
+
+<h2>Introduction</h2>
+<p>
+Hip replacements are common worldwide, but reasons for surgery and prevalence vary regionally. This dataset and analysis focus on understanding the underlying factors and evaluating patient outcomes using post-operative survey data.
+</p>
+
+<h2>Reasons for Hip Replacements</h2>
+<ul>
+  <li><strong>Osteoarthritis (Degenerative Joint Disease):</strong> Most common cause. Influenced by age, obesity, genetics, and injury.</li>
+  <li><strong>Rheumatoid Arthritis:</strong> Inflammatory condition leading to joint damage requiring surgery.</li>
+  <li><strong>Hip Fractures:</strong> Often due to trauma or osteoporosis, particularly in elderly individuals.</li>
+  <li><strong>Avascular Necrosis:</strong> Bone tissue death from disrupted blood flow. Causes include trauma, alcohol, and steroids.</li>
+  <li><strong>Congenital Hip Disorders:</strong> Conditions like developmental dysplasia (DDH) can lead to instability and pain, often requiring surgery.</li>
+</ul>
+
+<h2>Regional Differences</h2>
+
+<h3>Japan</h3>
+<ul>
+  <li><strong>Diet & Lifestyle:</strong> Fish-rich diets and regular low-impact activity help preserve joint health.</li>
+  <li><strong>Cultural Norms:</strong> Daily physical activity (e.g., walking, tai chi) helps prevent joint deterioration.</li>
+  <li><strong>Healthcare Access:</strong> Universal health coverage promotes early intervention and preventative care.</li>
+</ul>
+
+<h3>Western Northern Hemisphere Countries</h3>
+<ul>
+  <li><strong>Obesity:</strong> Higher obesity rates increase pressure on joints, accelerating wear.</li>
+  <li><strong>Sedentary Lifestyle:</strong> Prolonged sitting and inactivity contribute to joint stiffness and muscle weakness.</li>
+  <li><strong>Ageing Populations:</strong> Increased age correlates with higher hip replacement demand.</li>
+  <li><strong>Healthcare Disparities:</strong> Unequal access impacts preventative care and early detection.</li>
+</ul>
+
+<h2>Types of Surgical Procedures</h2>
+
+<h3>Hip Replacement (Arthroplasty)</h3>
+<ul>
+  <li><strong>Total Hip Replacement (THR):</strong> Most common procedure; entire joint is replaced with prosthetics.</li>
+  <li><strong>Partial Hip Replacement:</strong> Replaces only the femoral head; often used for femoral neck fractures.</li>
+  <li><strong>Resurfacing Hip Replacement:</strong> Caps femoral head instead of removing; for younger, active patients.</li>
+</ul>
+
+<h3>Hip Pinning (Internal Fixation)</h3>
+<ul>
+  <li><strong>Dynamic Hip Screw (DHS):</strong> Screw and plate system allowing controlled movement to promote healing.</li>
+  <li><strong>Cannulated Screws:</strong> Hollow screws guided into bone to secure fractures.</li>
+  <li><strong>Intramedullary Nailing:</strong> Metal rod inserted into the femur for complex fractures.</li>
+  <li><strong>Garden Screw Fixation:</strong> Screws stabilising the acetabulum area in pelvic fractures.</li>
+</ul>
+
+<h2>Provisional Patient Reported Outcome Measures (PROMs) – England</h2>
+<p>
+Since April 2009, patients undergoing hip/knee replacement surgeries are invited to complete pre- and post-operative questionnaires:
+</p>
+
+<h3>Condition-Specific Measures</h3>
+<ul>
+  <li><strong>Oxford Hip Score (OHS):</strong> 12-question form to assess pain and hip function. <a href="#">link</a></li>
+  <li><strong>Oxford Knee Score (OKS):</strong> Similar format for knee assessment. <a href="#">link</a></li>
+</ul>
+
+<h3>General Health Measures</h3>
+<ul>
+  <li><strong>EQ-5DTM Index:</strong> Measures five dimensions: mobility, pain/discomfort, anxiety/depression, self-care, and daily activity.</li>
+  <li><strong>EQ VAS:</strong> Visual scale from 0–100 representing overall health.</li>
+</ul>
+
+<h3>Additional Feedback</h3>
+<ul>
+  <li>Patient satisfaction and perceived success of the operation post-surgery.</li>
+</ul>
+
+<h2>Data Visualisations</h2>
+<p>
+Data from “<em>Key Facts Hip and Knee Replacements 2223.csv</em>” visualised using Google Sheets and R:
+</p>
+
+<h3>Survey Results – Average Hip Procedure Outcomes</h3>
+<ul>
+  <li><strong>EQ VAS (General Health):</strong> 67.53% improved, 6.70% unchanged, 25.80% worsened.</li>
+  <li><strong>EQ-5D Index (Quality of Life):</strong> 89.23% improved, 5.60% unchanged, 5.17% worsened.</li>
+  <li><strong>Oxford Hip Score (Hip Function):</strong> 95.07% improved, 1.17% unchanged, 3.73% worsened.</li>
+</ul>
+
+<h3>Possible Explanations for Discrepancies</h3>
+<ul>
+  <li><strong>Measure Specificity:</strong> EQ VAS is general; Oxford Hip Score is more targeted.</li>
+  <li><strong>Subjective Interpretation:</strong> Different perception of questions may influence scoring.</li>
+  <li><strong>Severity & Expectations:</strong> Patients with severe conditions may report lower satisfaction despite improvement.</li>
+  <li><strong>Pain Sensitivity:</strong> Varies across individuals, impacting subjective scores.</li>
+</ul>
+
+<h2>Further Visualisations using R</h2>
+<ul>
+  <li>Box plots comparing outcome percentages by status (Improved, Unchanged, Worsened).</li>
+  <li>Pie chart summarising overall distribution of results across questionnaires.</li>
+  <li>Combined dashboard view with custom colours and annotations.</li>
+  <li>R code and Markdown documents included. <a href="#">link</a></li>
+</ul>
+
+<h2>Conclusion</h2>
+<p>
+The analysis demonstrates that hip procedures generally lead to <strong>significant improvements</strong> in:
+</p>
+<ul>
+  <li>Self-reported health (EQ VAS)</li>
+  <li>Quality of life (EQ-5D)</li>
+  <li>Hip function (Oxford Hip Score)</li>
+</ul>
+
+<p>
+While some patients report no change or worsening, most benefit substantially. Differences across regions like Japan vs Western countries are shaped by lifestyle, diet, healthcare access, and societal factors. A comprehensive approach to prevention and care is key to maintaining long-term hip health and mobility.
+</p>
+
+<p><strong>Author:</strong> Patrick Ford 🩻</p>