Mortality, morbidity, and 1-year outcomes of primary elective total hip arthroplasty

Ahmed

et al. 2010

annals

INTRODUCTION There is anecdotal evidence of poorer outcomes from prosthetic joint replacement performed in independent treatment centres but very few comparative studies. PATIENTS AND METHODS We compared the early re-operation, dislocation, re-admission, major wound infection and audit rates of 880 total hip (THA) and 874 total knee (TKA) arthroplasties carried out at a regional orthopaedic hospital (Avon Orthopaedic Centre; AOC) with 368 THAs and 365 TKAs from an NHS (WGH) and 67 THAs and 86 TKAs from a private hospital (CNH) independent treatment centre. RESULTS Early re-operation rates were 9% at CNH, 1.4% at WGH and 0.6% at AOC after THA and 8% at CNH, 1.9% at WGH and 1% at AOC after TKA. After THA, dislocation rates after THA were 6% at CNH and 1.8% at both WGH and AOC. Readmission rates were 13% at CNH, 0.6% at WGH and 1.2% at AOC. Major wound problems were 20% at CNH, 3.8% at WGH and 0.4% at AOC after THA and 19% at CNH, 1.9% at WGH and AOC (1.1%) after TKA. After TKA, re-admission rates from CNH were 13%, 1% at WGH and 1.1% at AOC. AOC and WGH audited their outcomes. None were available from CNH. CONCLUSIONS Results and audit from independent treatment centres are variable and patients should be warned of this before undergoing treatment at them.

Section: Discussionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 90%

Early complications of total hip and knee replacement: a comparison of outcomes in a regional orthopaedic hospital and two independent treatment centres

Ahmed

et al. 2010

annals

Arthritis Care & Research

“…However, other data referred to in the Introduction (4,11,12) suggest that many people are dissatisfied with their hip surgery; therefore, the operation may not achieve the expected relief of pain and disability from the hip joint in a proportion of people.…”

Section: Discussionmentioning

confidence: 99%

“…However, increasing emphasis is currently being placed on patient-reported outcome measures and patient satisfaction, which may not mirror the technical outcome of surgery (10). Recent studies in the UK (11), Canada (12), and Sweden (4) have all shown that an important minority of patients having THR are not satisfied with the outcome.…”

Section: Introductionmentioning

confidence: 99%

Patient‐reported outcomes one year after primary hip replacement in a European Collaborative Cohort

Judge¹,

Cooper²,

Williams³

et al. 2010

133

Results. On average, there was a large improvement in WOMAC scores 12 months after surgery, but whereas some patients improved, others got worse. The OMERACT-OARSI method classified 85.7% of patients as responders, MID 70.1%, and return to normal 64.1%. In general, each approach classified the same groups of patients as responding to THR. Based on total WOMAC score, patients who were younger, morbidly obese, employed, and better educated were more likely to respond to THR, but the effects were attenuated after adjustment for confounding, with only the effect of education remaining important. Conclusion. The overall average response to THR was good, but ϳ14 -36% of patients did not improve, or were worse, 12 months postsurgery. Although the OMERACT-OARSI criteria were originally designed for use in clinical drug trials, they performed well in classifying patient response 12 months post-THR. Further research is required to understand the determinants of patient outcomes following THR.

“…1,2 The estimated cost of caring for pressure sores is estimated at £150 million a year in the UK and more than $3 billion in the US. 2 Pressure sore incidence is recognised as a marker of quality of care:…”

mentioning

confidence: 99%

Pressure sores following elective total hip arthroplasty: pitfalls of misinterpretation

Keong¹,

Ricketts²,

Alakeson³

et al. 2004

Ann R Coll Surg Engl

On analysis, the data collection system was revealed to be flawed. Grade 1 areas (erythema with no ulceration) were included, leading to a dramatic discrepancy between reported and confirmed pressure sores. Re-analysis showed the confirmed pressure sore rates to be much lower (2.3% NHS, 1.0% private hospital). Conclusions: This audit suggests that both poor data collection and education lead to inaccurate audit. This may lead to subsequent inappropriate management and inappropriate NHS star ratings.