Patients self-present for revision arthroplasty: Results from the UK SAFE study

Smith, Lindsay; Czoski-Murray, Carolyn; Kingsbury, Sarah; Shuweildi, Farag; West, Robert; Conaghan, Philip; Stone, Martin

Abstract

Background
A group of patients with hip or knee joint replacements was studied to assess whether they might self-present for revision surgery if they were not under long term follow-up. In an observational cohort study of patients undergoing revision joint replacement, we identified a group of patients who were not receiving long-term orthopaedic follow-up and did not report problems with their joint replacement prior to revision.
Methods
Data were collected from participants and from research nurses about the 12-month period prior to revision and their original primary surgery. Participants were retrospectively classified as in a ‘follow-up’ or ‘no follow-up’ group. We examined a sub-group of ‘no follow-up’ participants who recorded that they did not experience any problems prior to revision. We analysed the data from this group for any possible reasons to self-present in primary or secondary care for revision arthroplasty.
Results
Out of 568 participants in the study, 84 (15%) fulfilled our criteria for ‘no problems’ with their replacement prior to revision (55 hips and 29 knees). Of this ‘no problem’ group, 42 hips and 19 knees replacements were classified in the no follow-up group. We excluded patients revised for peri-prosthetic fracture, dislocation, implant failure or infection from our study group as these patients will present to medical services due to symptoms whether under follow-up or not. After exclusions, there were 11 participants with hip revision and 7 undergoing knee revision.
In this group, 17 of the 18 participants reported symptoms at the time of revision. Revision for the remaining one participant was for an incidental x-ray finding during follow-up for another joint.
Conclusion/Findings
The findings of this study suggest that revision hip or knee replacement is currently undertaken when there are symptoms, and that patients will self-present if not under long-term follow-up.
Implications
A system of self-referral directly to orthopaedic screening services for arthroplasty patients may provide the route for timely revision surgery as an alternative to routine surveillance for this patient group.

• Presentation Conference Type: Poster
• Conference Name: British Orthopaedic Association Virtual Congress 2020
• Start Date: Sep 15, 2020
• End Date: Sep 25, 2020
• Deposit Date: Oct 27, 2020
• Publicly Available Date: Nov 5, 2020
• Public URL: https://uwe-repository.worktribe.com/output/6814309
• Publisher URL: https://www.boa.ac.uk/annual-congress/posters.html