Should follow-up of patients with arthroplasties be carried out by general practitioners?

Haddad, Fares S.; Ashby, Eric; Konangamparambath, S.

doi:10.1302/0301-620x.89b9.19697

Cited by 24 publications

(20 citation statements)

References 3 publications

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“…22 Spiralling health-care costs may force a decrease in the length of follow-up after a THR with the results that asymptomatic loosening is not identified at an early stage with an increase in risk of subsequent fracture. 23 Our results confirm the reliability and reproducibility of the Vancouver classification system. In addition, we have shown that substantial agreement can be found between individuals with no specialist training.…”

Section: Discussionsupporting

confidence: 81%

European validation of the Vancouver classification of periprosthetic proximal femoral fractures

Rayan

Dodd

Haddad

2008

The Journal of Bone and Joint Surgery. British volume

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118

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The Vancouver classification has been shown by its developers to be a valid and reliable method for categorising the configuration of periprosthetic proximal femoral fractures and for planning their management. We have re-validated this classification system independently using the radiographs of 30 patients with periprosthetic fractures. These were reviewed by six experienced consultant orthopaedic surgeons, six trainee surgeons and six medical students in order to assess intra- and interobserver reliability and reproducibility. Each observer read the radiographs on two separate occasions. The results were subjected to weighted kappa statistical analysis. The respective kappa values for interobserver agreement were 0.72 and 0.74 for consultants, 0.68 and 0.70 for trainees on the first and second readings of the radiographs and 0.61 for medical students. The intra-observer agreement for the consultants was 0.64 and 0.67, for the trainees 0.61 and 0.64, and for the medical students 0.59 and 0.60 for the first and second readings, respectively. The validity of the classification was studied by comparing the pre-operative radiological findings within B subgroups with the operative findings. This revealed agreement for 77% of these type-B fractures, with a kappa value of 0.67. Our data confirm the reliability and reproducibility of this classification system in a European setting and for inexperienced staff. This is a reliable system which can be used by non-experts, between centres and across continents.

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Section: Discussionsupporting

confidence: 81%

European validation of the Vancouver classification of periprosthetic proximal femoral fractures

Rayan

Dodd

Haddad

2008

The Journal of Bone and Joint Surgery. British volume

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118

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“…Hacking et al33 performed a prospective analysis of 110 THAs over a four-year period, and they found that only four (3.6%) of the 110 cases were for asymptomatic revisions in the first seven years after primary THA. Other studies supported “no follow-up” until several years after primary THA 58,59. The findings in the present study corroborated these results.…”

Section: Discussionsupporting

confidence: 92%

The Cost of Routine Follow-Up in Total Joint Arthroplasty and the Influence of These Visits on Treatment Plans

Hendricks

Chong

Cusick

2019

kjm

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IntroductionMany physicians recommend annual or biennial visits after total hip and knee arthroplasty (THA and TKA). This study sought to establish the cost of a post-operative visit to both the health care system and patient and identify if these visits altered patient management.MethodsA prospective cohort study was conducted using patients presenting for follow-up after THA or TKA from April through December 2016. All surgeries were performed by a single orthopaedic surgeon in Wichita, Kansas. All eligible subjects that met the inclusion criteria received and completed a questionnaire about the personal cost of the visit and their assessment of their function and outcome after total joint arthroplasty. The physician also completed a questionnaire that examined the cost of the visit to the health care system and whether the clinical or radiographic findings altered patient management.ResultsFifty-six patients participated with an average length of follow- up of 4.5 ± 4.1 years since surgery. The average patient cost was $135.20 ± $190.53 (range, $1.65 – $995.88), and the average visit time for the patient was 3.9 ± 2.9 hours. Eighty percent of patients reported no pain during the clinic encounter, and 11% reported loss of function. Eighty-four percent thought the visit was necessary. Physician time for each visit lasted 12.9 ± 3.7 minutes (range, 10 – 20 minutes). Only 9% of patient encounters resulted in an alteration in patient management. This occurred at an average follow-up time of 3.6 ± 1.8 years after the index procedure. The average cost of each visit to the health care system at large was $117.31 ± 60.53 (range, $93.90 – $428.28).ConclusionsThe findings of this study advise total joint patients and orthopaedic surgeons regarding the cost of routine post-operative appointments and whether these visits alter patient management. The majority of the routine follow-up visits after THA and TKA did not result in an alteration in patient management, but added substantial cost to the health care system.

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“…Currently, revision surgery constitutes 12% of all hip arthroplasty procedures in the National Joint Registry, the largest group constituting those undertaken for aseptic loosening or osteolysis (National Joint Registry, 2013). These conditions are often silent at onset and, if undetected, may lead to substantial loss of bone with subsequent peri-prosthetic fracture and a significantly higher cost of revision than for aseptic loosening alone (Haddad et al, 2007;Ghoz and Macdonald, 2008;Huddleston et al, 2010). This situation is more challenging for the orthopaedic surgeon and is associated with a higher risk for the patient (Paprosky et al, 2001;Barrack, 2004;Howard, 2009;Vanhegan et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

A Survey of the Current State of Hip Arthroplasty Surveillance in the United Kingdom

Smith

2014

Musculoskeletal Care

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Should follow-up of patients with arthroplasties be carried out by general practitioners?

Cited by 24 publications

References 3 publications

European validation of the Vancouver classification of periprosthetic proximal femoral fractures

European validation of the Vancouver classification of periprosthetic proximal femoral fractures

The Cost of Routine Follow-Up in Total Joint Arthroplasty and the Influence of These Visits on Treatment Plans

A Survey of the Current State of Hip Arthroplasty Surveillance in the United Kingdom

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