Development of assessment in hip arthroplasty review

Smith, Lindsay K

Abstract

Abstract

This thesis describes the development of criteria in hip arthroplasty review. The insertion of a hip replacement brings relief from pain and improved function but the artificial joint does not last indefinitely. Periodic review provides the opportunity to assess the state of the joint in order to identify a failing hip arthroplasty.

A literature search was conducted on the subject of failing hip arthroplasty and the findings are summarised. There was a lack of standardisation of methodology but an emphasis on the need for review because of the commonly asymptomatic nature of a failing hip arthroplasty.

The review process has traditionally been completed by medical members of the orthopaedic team but there has been a recent change to include non-medical health professionals in this work. A lack of formalised educational programmes has led to innovative ways of achieving the required competency, and one such method is described for the development of a skill in interpretation of x-ray images of hip replacements.

Radiographic assessment is an important component of hip arthroplasty review and includes the measurement of osteolytic lesions, a phenomenon caused by the wear particles produced from the articulating surfaces of the artificial joint. A simple, clinical tool was developed to measure these irregularly shaped lesions and the testing of the tool is described.

Finally, a clinical study was conducted to explore the association between changes on a patient reported outcome measure and x-ray changes over the same period of time. The patients had all received a hip replacement approximately seven years earlier (mid-term) and so were at a stage when signs of deterioration of the hip joint were likely to appear.

This thesis makes a contribution to the scientific base of arthroplasty review. It demonstrates a training model for non-medical health professions to acquire the skills needed to conduct the review. It employs basic research to develop a simple and reliable tool for use in the clinical situation. It shows that, for patients reviewed at mid-term, it is essential to include an x-ray as well as a joint-specific patient reported outcome measure. This information is important for future service planning and development of practitioners, and is of benefit to patients through adding to the evidence about the criteria for arthroplasty review.

• Thesis Type: Thesis
• Publicly Available Date: Jun 8, 2019
• Keywords: hip, replacement, arthroplasty, assessment, review, follow up, total hip
• Public URL: https://uwe-repository.worktribe.com/output/957353