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

Abstract

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.

Prosthetic hip dislocations: Is relocation in the emergency department by emergency medicine staff better?

“…Prosthetic hip dislocation occurs in 1-10% of patients after total hip arthroplasty. 1 About 7000 primary hip joint replacements and 100 revisions are carried out annually in New Zealand. 2 The majority of primary dislocations are posterior and occur within the first three postoperative months.…”

Effect of an independent-sector treatment centre on provision of elective orthopaedic surgery in east and north hertfordshire

“…[6][7][8] Bannister et al compared the outcomes for total replacement of the hip and knee carried out in a local AHT compared with two regional ISTCs. 8 They reported considerable variation in outcome, with a marked increase in the prevalence of reoperation and wound complications, as well as a trend towards a higher prevalence of hospital readmission for arthroplasty, carried out at ISTCs. The findings from the present study enable an informed opinion with regard the stated aims of ISTCs.…”

“…Further information is also taken from a comprehensive report on ISTCs from the House of Commons (HoC). 8 With regard to increasing elective capacity available to the NHS to reduce waiting lists and waiting times, evidence from the HoC Health Committee Report 1 stated that ISTCs provided only a modest increase in capacity. This report detailed that, as of December 2005, ISTCs had carried out 44,000 elective surgical procedures and 9,000 diagnostic procedures, with phase-I centres expected to carry out a mean of 170,000 Finished Consultant Episodes (FCEs) each year over 5 years.…”

Factors influencing the outcome of deep infection following total knee arthroplasty

“…Kreder et al [20] reported that a low hospital procedure volume was significantly associated with an increased rate of readmission within one year after TKA, and low surgeon volume was related to a longer hospital stay. In addition, Bannister et al [21] reported that the number of major wound infections at hospitals with few joint replacements was 17 times greater than that at the hospitals with many joint replacements. Ong et al [22] reported that patients who underwent TKA at high-volume hospitals or by high-volume surgeons are more likely to undergo shorter operative procedures than those operated at low-volume hospitals or by lowvolume surgeons.…”