Monitoring the quality of total hip replacement in a tertiary care department using a cumulative summation statistical method (CUSUM)

Abstract

The purpose of this study was to define immediate post-operative 'quality' in total hip replacements and to study prospectively the occurrence of failure based on these definitions of quality. The evaluation and assessment of failure were based on ten radiological and clinical criteria. The cumulative summation (CUSUM) test was used to study 200 procedures over a one-year period. Technical criteria defined failure in 17 cases (8.5%), those related to the femoral component in nine (4.5%), the acetabular component in 32 (16%) and those relating to discharge from hospital in five (2.5%). Overall, the procedure was considered to have failed in 57 of the 200 total hip replacements (28.5%). The use of a new design of acetabular component was associated with more failures. For the CUSUM test, the level of adequate performance was set at a rate of failure of 20% and the level of inadequate performance set at a failure rate of 40%; no alarm was raised by the test, indicating that there was no evidence of inadequate performance. The use of a continuous monitoring statistical method is useful to ensure that the quality of total hip replacement is maintained, especially as newer implants are introduced.

Patient injuries in primary total hip replacement

“…Another study monitoring the quality of THR found that approximately 25% of all THRs failed due to factors related to technical errors (Biau et al. 2011 ). The types of injury and their frequencies found in the present study were also very similar to those reported earlier for closed malpractice claims of THR recipients in the USA (Matsen et al.…”

“…Acetabular-side errors have previously been shown to account for half of all technical errors in THRs (Biau et al. 2009 , 2011 ), and up to 60% of acetabular components have been shown to be in a suboptimal position, depending on the target ranges used (Barrack et al. 2013 , Lee et al.…”

Using the CUSUM Test to Control the Proportion of Inadequate Open Biopsies of Musculoskeletal Tumors

“…Patients, doctors, and public health authorities are using these methods to detect and, if necessary, correct inadequate performance [6,9,10,23,24]. The use of these methods such as the cumulative summation (CUSUM) test [17] has been proposed in various surgical and interventional specialties [2,5,11,15,18]. This control chart is designed to detect the deviation from target of some characteristic of a product.…”

“…This control chart is designed to detect the deviation from target of some characteristic of a product. For instance, it may be used to detect an increase in the postoperative infection rate or in the proportion of THAs that fails to meet some prespecified standards [2]. These methods provide ongoing feedback to physicians learning a technique [18], using new implants [2], or simply attempting to reach some target level of technical competence [6,11].…”

“…For instance, it may be used to detect an increase in the postoperative infection rate or in the proportion of THAs that fails to meet some prespecified standards [2]. These methods provide ongoing feedback to physicians learning a technique [18], using new implants [2], or simply attempting to reach some target level of technical competence [6,11]. Because open biopsies impose some risk potentially adversely affecting the final outcome of the patient [12,13], using a tool that can provide ongoing feedback regarding the adequacy of this procedure is relevant and has not been done before.…”