Association between outpatient follow-up and incidence of revision after knee and hip replacements: a population-based cohort study

Pinedo-Villanueva, Rafael; Kolovos, Spyros; Burn, Edward; Delmestri, Antonella; Smith, Lindsay K.; Judge, Andrew; Kingsbury, Sarah R.; Stone, Martin H.; Conaghan, Philip G.

Abstract

Background: Follow-up visits 5 or 7 years after surgery were recommended for people having primary hip or knee replacement. The benefits of this practice to patients and the healthcare system, however, have not yet been specifically examined. The aim of this study was to investigate the association between long-term follow-up outpatient hospital visits and revision rates for patients who undergo primary knee or hip replacement surgery. Methods: Cohorts were identified for patients undergoing knee or hip replacement surgery using medical records from primary care practices within the UK Clinical Practice Research Datalink (CPRD) GOLD dataset linked to hospital records from the English Hospital Episodes Statistics (HES) data. Two groups of patients were compared in terms of revision and mortality rates: those with at least one long-term (between five and 10 years since primary surgery) follow-up visit at the orthopaedic department (‘Follow-up’ group), and those without (‘No follow-up’ group). Results: A total of 9856 (4349 in the Follow-up group) patients with knee replacement and 10,837 (4870 in the Follow-up group) with hip replacement were included in the analysis. For knee replacement, the incidence of revision was 3.6% for those followed-up and 0.6% for those not followed-up. An adjusted regression model confirmed the difference in the hazard ratio (HR) for revision was statistically significant (HR: 5.65 [95% CI 3.62 to 8.81]). Mortality at 4 years was lower for the Follow-up (17%) compared to the No follow-up group (21%), but this difference was not statistically significant (HR: 0.95 [0.84 to 1.07]). For hip replacement, the incidence of revision rates were 3.2 and 1.4% for the follow-up and not follow-up groups, respectively, the difference being statistically significant (HR: 2.34 [1.71 to 3.20]). Mortality was lower for the Follow-up (15%) compared to the No follow-up group (21%), but the difference was not statistically significant (HR: 0.91 [0.81 to 1.02]). Conclusion: Patients attending follow-up orthopaedic consultations show a higher risk of revision surgery compared to those who are not followed-up. A cause for this difference could not be identified in this study but a likely explanation is that surgeons play an effective role as ultimate arbitrators when identifying patients to be included in long-term follow-up lists.

• Journal Article Type: Article
• Acceptance Date: Jan 23, 2023
• Online Publication Date: Feb 8, 2023
• Publication Date: Feb 8, 2023
• Deposit Date: Feb 14, 2023
• Publicly Available Date: Feb 15, 2023
• Journal: BMC Musculoskeletal Disorders
• Print ISSN: 1471-2474
• Electronic ISSN: 1471-2474
• Publisher: BioMed Central
• Peer Reviewed: Peer Reviewed
• Volume: 24
• Issue: 1
• Pages: 106
• DOI: https://doi.org/10.1186/s12891-023-06190-7
• Keywords: Orthopedics and Sports Medicine; Rheumatology; Osteoarthritis; Joint replacement surgery; Follow-up; Revision surgery; Mortality; Hip; Knee
• Public URL: https://uwe-repository.worktribe.com/output/10442603
• Publisher URL: https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-023-06190-7
• Additional Information: The study was conducted in accordance with the Declaration of Helsinki and all analyses were performed in accordance with the relevant guidelines and regulations. The study obtained ethical approval from a National Research Ethics Committee (REC) and has been approved by the Independent Scientific Advisory Committee (ISAC) for Medicines and Healthcare products Regulatory Agency (MHRA) Database Research with protocol number 11_050AMnA2RA2. This work uses anonymised healthcare routinely collected data securely shared by GP practices across the UK and provided by Clinical Practice Research Datalink (CPRD). CPRD only receives and supplies anonymised patient data and complies with robust ethics, governance and security regulatory frameworks. The patient health data that CPRD holds have been processed in accordance with the Information Commissioner’s Office (ICO) Anonymisation Code of Practice. Individual patients have the right to opt out of their data being collected by CPRD for research.; : Not applicable. Individual patients have the right to opt out of their data being collected by CPRD for research.; : The institution of one or more of the authors (RPV, SK, EB, AD, LKS, AJ, SRK, and PGC) has received funding from the National Institute for Health Research (NIHR) to conduct this study. One or more of the authors (AJ) has received further funding from NIHR. MHS has no competing interests to declare.; ; This article is licensed under a Creative Commons Attribution 4.0 International License. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.