14:30-15:05
Chaired by Prof Steve Gwilym
Oxford has a strong commitment to academia, often based at the Botnar. At any given time, about one fifth of our trainees are out of training for dedicated research time, often for a higher degree. This session will showcase some of the work going on in region.
Primary total hip arthroplasty (THA) is a commonly performed and successful operation, which orthopaedic trainees must demonstrate competence in prior to completion of training. This study aims to define 1-year patient mortality and all-cause revision rates following primary THA for trainee-led (TL) compared to consultant-led (CL) operations.
National Joint Registry data access was granted for all elective primary THA performed in a single University Teaching Hospital from 2006-2021. Data analysis was performed on the 15-year dataset and split 5-year blocks (B1=2006-2010; B2=2011-2015; B3=2016-2020). Survival and multivariate logistic regression analysis were performed for both outcome measures (mortality/revision) in relation to lead surgeon grade (TL/CL), patient demographics, and implant fixation.
10,425 primary THA were recorded: 5786 CL (55.5%), and 4639 TL (44.5%). Overall, 1-year patient mortality was 2.1% (n=216), and all-cause revision was 1.1% (n=116). No significant difference in 1-year mortality was found between TL (n=86, 1.9%) compared to CL (n=130, 2.2%) operations (p=0.2, OR 0.8, CI 0.57-1.12). Overall, there was no statistically significant difference in the risk of 1-year revision between TL (n=61, 1.3%) and CL (n=55, 1.0%) operations (p=0.059, OR 1.49, CI 0.99-2.27). Statistically significant increased revision rates amongst TL operations were found for B3 (n=31 (2.0%) vs n=17 (0.9%) respectively, p=0.015, OR 2.21, CI 1.19-4.32), but not B1 or B2.
TL primary THA is associated with an increased and temporally increasing risk of patient 1-year all-cause revision, but not mortality in comparison to CL operations. This finding has implications for both training and the NJR profiles of consultant trainers.
Telemedicine offers convenient and affordable healthcare, overcoming the logistical challenges of face-to-face encounters. Clinicians increasingly relied on telemedicine during the global pandemic. To assess the ongoing role for telemedicine in Orthopaedics, we prospectively analysed the efficacy, safety and patient reported experience of telephone consultations for 12 months.
265 telephone Foot/Ankle consultations were conducted in April 2020 and were prospectively analysed over 12 months. The primary outcome measure was the effectiveness of the telephone consultations. A consultation was deemed ineffective if the patient did not answer, if the clinician could not reach a conclusion or if any outcome changed over 12 months. Secondary outcome measures included patient reported satisfaction and time saved by avoiding a face-to-face visit.
A valid clinical decision was reached in 84% of Follow-up tele-consultations and 64% of new patient consultations (p=0.001). 66% were managed with non-operative therapies, 16% were discharged and 11% were added to the waiting list for surgery. The reasons for failing to achieve a valid clinical decision included: failure to contact the patient (12.8%); inappropriate discharge with subsequent re-referral (1.9%); and insufficient clinical information (1.5%). 84.7% of patients reported that the telephone consultation was highly useful and 71.9% would recommend it to a friend or family member. Patients reported a mean time saving of 120 minutes.
Based on our experience we provide recommended criteria for the safe and effective use of telephone consultations and suggest versatile patient care pathways into which a telemedicine consultation can be effectively and safely incorporated.
Title: TBC
To compare rates of serious adverse events in patients undergoing revision knee arthroplasty with consideration of the indication for revision (urgent versus elective indications) and compared these with primary arthroplasty and re-revision arthroplasty.
Patients undergoing primary knee arthroplasty were identified in the national Hospital Episode Statistics (HES). Subsequent revision and re-revision arthroplasty procedures in the same patients and same knee were identified. The primary outcome was 90-day mortality and a logistic regression model was used to investigate factors associated with 90-day mortality and secondary adverse outcomes including infection (undergoing surgery), pulmonary embolism, myocardial infarction, stroke. Urgent indications for revision arthroplasty were defined as infection or fracture, and all other indications (e.g. loosening, instability, wear) were included in the elective indications cohort.
939,021 primary knee arthroplasty cases were included (939,021 patients) of which 40,854 underwent subsequent revision arthroplasty, and 9,100 underwent re-revision arthroplasty. Revision surgery for elective indications was associated with a 90-day rate of mortality of 0.44% (135⁄30,826; 95% CI 0.37 to 0.52) which was comparable to primary knee arthroplasty (0.46%; 4,292⁄939,021; 95% CI 0.44 to 0.47). Revision arthroplasty for infection, however, was associated with a much higher mortality of 2.04% (184⁄9037; 95% CI 1.75 to 2.35; odds ratio [OR] 3.54; 95% CI 2.81 to 4.46), as was revision for periprosthetic fracture at 5.25% (52⁄991; 95% CI 3.94 to 6.82; OR 6.23; 95% CI 4.39 to 8.85). Higher rates of pulmonary embolism, myocardial infarction, and stroke were also observed in the infection and fracture cohort.
Patients undergoing revision arthroplasty for urgent indications (infection or fracture) are at high risk of mortality and other serious adverse events in comparison to primary knee arthroplasty and revision arthroplasty for elective indications. These findings will be important for patient consent and shared decision making and should inform service design for this patient cohort.