Provision of revision knee surgery and calculation of the effect of a network service reconfiguration: An analysis from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man

Revision total knee replacement case-mix at a major revision centre

“…For patients who were referred to the major revision centre over the study period, the referral source was classified as follows: primary care, primary arthroplasty unit (< 20 revisions per year), revision unit (20–70 revisions per year), and major revision centre (> 70 revisions per year). The revision volume thresholds for classification represent those proposed by the British Association for Surgeons of the Knee (BASK) Revision Knee Working Group [ 8 ]. Classification was based on publicly available 36-month practice profiles from the NJR website [ 14 ].…”

“…The planning for a rTKR network has included characterisation of operative caseloads for surgeons and units currently performing rTKR [ 8 ]. There is some evidence to suggest that higher-volume units may achieve better outcomes following surgery [ 9 ].…”

Integrated care systems in trauma to elective care: Can we emulate the integration of services in orthopaedic trauma care within elective practice?

“…Centralization of complex orthopaedic elective services within the UK was piloted in 2015, 14 with more recent studies from the British Association for Surgery of the Knee (BASK) providing an exploratory analysis and hypothetical models of case redistribution in a network reconfiguration. 15 Despite these early steps, or perhaps, in part, because of some of the methods employed, this arthroplasty network is yet to come to fruition. Evidence of the need for change is strong; there has been exponential growth in waiting lists without resolution, 9 and there is potential for improvement in patient outcomes, collaborative research opportunities, and dissemination of best practice.…”

“…The authors elaborated upon the many immeasurable system factors, which intuitively appear to be fundamental, including the value of multidisciplinary input for complex cases and experienced theatre teams. 15 …”

Integrated care systems, research, and innovation

“… 26 - 30 Despite the regionalization of orthopaedic trauma services through collaborative networks within the UK nearly a decade ago, this has not yet been reciprocated in our elective care. 31 - 33 …”