2023 ISAKOS Biennial Congress ePoster
Design, Construction, And Early Results Of A Formal Local Revision Hip Arthroplasty Registry
Christopher J. Wilson, A/Prof, MBChB, MRCS, FRACS, PhD, Adelaide, SA AUSTRALIA
Ben Piotrowski, MD Student, Highbury, SA AUSTRALIA
Flinders Medical Centre, Flinders University, Adelaide, South Australia, AUSTRALIA
FDA Status Not Applicable
Summary
. The aim is to evaluate the performance of our local hospitals against the national standard to improve patient outcomes and care. Our research shows that the use of a standardised diagnostic algorithm was instrumental in improving our surgical outcomes for hip revision arthroplasty.
ePosters will be available shortly before Congress
Abstract
National Registries for arthroplasty surgery have been successful in improving outcomes and quality control by large scale data collection and analysis. Data from the national registry has suggested room for improvement in our local revision hip arthroplasty outcomes. Using this data we have a standardised diagnostic and management pathway for revision hip arthroplasty combined with a local revision hip arthroplasty registry provides granular data applicable to our local hospitals. The aim is to evaluate the performance of our local hospitals against the national standard to improve patient outcomes and care. This is achieved through comparing data of revision types, revision diagnosis and incidence of revisions performed.
In our centre in 2014 we introduced a standardised diagnostic algorithm for hip revision arthroplasties. From December 2014 to December 2020, our centre applied the algorithm to all cases of revision hip arthroplasty and investigated their indication. This data was then compared with the results procured from the with Australian Orthopaedic Association National Joint Replacement Registry.
The primary outcome of our research was used to compare hip revision arthroplasty at our centre pre and post the algorithm intervention whilst simultaneously comparing against national standards. The secondary outcome was to analyse the re-revision rates of hip arthroplasty’s pre and post intervention and locally vs nationally. Re-revision rates was used as a proxy of the success of our initial revision surgeries. Finally, our third outcome was to analyse the propensity of our centre to perform more minimally invasive hip arthroplasty procedures.
When comparing with historical local data, the diagnosis of “Loosening” decreased (25.0% vs. 14.1%), “Infection” had increased (23.2% to 29.6%) and “Fracture” had increased (12.5% to 18.5%). Additionally, Our Centre improved our proportion of “minimally invasive” revision types from 25.7% to 40.7%. When comparing our historical data to national standard at 8+ years since the primary procedure, our centre was 28% more likely to perform hip revision arthroplasty (HR = 0.72).
Our historical data showed a higher rate of re-revision hip surgery compared to the national average. After implementation of our diagnostic pathway the re-revision rate fell to below national average and the reduction was significant. (p=0.047)
Our research shows that the use of a standardised diagnostic algorithm was instrumental in improving our surgical outcomes for hip revision arthroplasty. We have increased our use of more conservative revision surgery and our rates of re-revision surgery have significantly reduced.