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Short-term results of total hip replacements performed by visiting surgeons at an NHS treatment centre
S P White1, A W John, S A Jones
1Department of Orthopaedics, University Hospital Llandough, Penarth CF64 4XX, UK. sw@cardiffarthritis.co.uk
Insights
Transferring patients for total hip replacement led to high revision rates and complications. This initiative significantly increased workload, exceeding expected failure rates and necessitating further corrective procedures.
Area of Science:
- Orthopedic Surgery
- Biomedical Engineering
Background:
- Initiative to reduce total hip replacement waiting times by transferring patients.
- Concerns arose regarding patient outcomes post-transfer.
Purpose of the Study:
- To evaluate the outcomes of total hip replacements performed at an NHS Treatment Centre.
- To assess the complication and revision rates associated with this patient transfer initiative.
Main Methods:
- Retrospective review of 98 patients (113 hips) after a mean of 23 months.
- Analysis of radiographic parameters including acetabular inclination and femoral component alignment.
- Documentation of complications, revision surgeries, and reasons for revision.
Main Results:
- High rates of radiographic abnormalities: acetabular inclination >55 degrees (16%), varus femoral component (42%), medial floor breach (12%).
- Significant complication rate: dislocations (3), fractures (1), infections (3).
- Elevated revision rate: 13% revised, 4% awaiting revision, primarily for painful loose acetabular components, far exceeding registry benchmarks.
Conclusions:
- The patient transfer initiative resulted in a high rate of complications and revisions for total hip replacement.
- Suboptimal component positioning and fixation contributed to adverse outcomes.
- The initiative led to a substantial increase in workload for the referring unit due to the need for corrective procedures.
Abstract:
Between December 2004 and June 2006, 136 patients (156 total hip replacements), were sent from the waiting list of the Cardiff Vale NHS Trust to the NHS Treatment Centre, Weston-super-Mare, in an attempt to reduce the waiting time for total hip replacement. Because of concerns about their outcome, each patient was contacted and invited to attend a review appointment with a consultant specialising in hip and revision hip replacement. A total of 98 patients (113 hips) were reviewed after a mean of 23 months (11 to 30). There were 104 cemented hips, seven hybrid and two cementless. An acetabular inclination of > 55 degrees was seen in 18 (16%). Radiolucent lines around the acetabular component were seen in 76 (67%). The femoral component was in more than 4 degrees of varus in 47 (42%). The medial floor had been breached in 13 (12%) and there was a leg-length discrepancy of more than 1 cm in ten (9%). There were three dislocations, one femoral fracture, one pulmonary embolus, one deep infection and two superficial wound infections. To date, 13% (15 hips) have been revised and a further 4% (five hips) await revision, mostly for a painful loose acetabular component. The revision rate far exceeds the 0.5% five-year failure rate reported in the Swedish Registry for the components used. This initiative and the consequent need for correction of the problems created, has significantly increased the workload of our unit.