A comparative study of patients presenting for revision of hip or knee replacements, based on whether they were or were not under long term follow-up

Kingsbury, Sarah; Smith, Lindsay; Shuweilkhi, Farag; West, Robert; Czoski-Murray, Carolyn; Vernon, Lema; Congahan, Philip; Stone, Martin

Abstract

Background: This prospective cohort study explored differences in symptoms, healthcare use, reason for revision, and the revision surgery (surgical time, components, length-of-stay) between patients having regular follow-up and those without.

Methods: Data were collected from participants and medical records for the 12 months prior to revision. Patients with previous revision, metal-on-metal or hip hemi-arthroplasty were excluded. Participants were retrospectively classified to a ‘follow-up’ or ‘no follow-up’ group. Multi-level regression and propensity score matching compared the 2 groups.

Results: 568 patients were enrolled at 35 UK secondary care sites between October 2017 and October 2018 (43.5% male; mean (SD) age 71.86 (9.93) years; 305 hips, 263 knees). No significant inclusion differences were identified between the Follow-up and No Follow-up groups.
For hip revision, male gender (OR 1.975, 95%CI[1.083-3.602], p=0.026) and time-to-revision>10 years (OR 3.804, 95%CI[1.353-10.694], p=0.011) were associated with Follow-up. Periprosthetic fracture (OR 20.309, 95%CI[4.574-90.179], p10 years (OR 2.337, 95% CI[1.007-5.419], p=0.048) and infection (OR 2.946, 95%CI[1.046-8.298], p=0.041) were associated with No Follow-up.
No other significant differences in cost outcomes, length of surgery time and access to a health professional in the 12 months prior to revision were found between the two groups for either hip or knee patients. However, there was a trend for increased length-of-stay and increased surgery time for hip revisions in the No Follow-up group, which was retained when periprosthetic fractures were excluded.

Conclusion: There are differences between patients presenting for revision through follow-up and no follow-up routes. Possible reasons for these differences will be presented.

Implications: This study formed part of the evidence used to inform the development of recommendations for follow-up of hip and knee surgery patients as part of the UKSAFE programme (HS&DR 14/170/96).

• Presentation Conference Type: Conference Paper (published)
• Conference Name: British Orthopaedic Association Virtual Congree 2020
• Start Date: Sep 14, 2020
• End Date: Sep 25, 2020
• Acceptance Date: Aug 24, 2020
• Online Publication Date: Sep 25, 2020
• Publication Date: Sep 25, 2020
• Deposit Date: Oct 27, 2020
• Public URL: https://uwe-repository.worktribe.com/output/6814385
• Publisher URL: https://www.boa.ac.uk/abstracts2020.html
• Additional Information: BOA Virtual Congress 2020/Abstracts/Hip/Accepted abstracts: Part I: 514