Arthroplasty patient follow up - When should we stop?

Dr Ahmed Mahmoud - Dr Stewart Wales - Dr Bi Ying Xie - Dr Philip Rowell 

Aim: To assess the cost effectiveness of arthroplasty clinic in identifying asymptomatic complication and whether this leads to change in management of patient. Secondarily, we aim to identify the critical time points for follow up.

Hypothesis: Arthroplasty clinic is not cost effective and does not change management of patients for follow up longer than a year.

Background: Regular long-term clinic follow-up of post-operative arthroplasty patients aims to detect early clinical symptoms and/or radiographic evidence of complications. However, complications leading to revision are mostly detected in symptomatic individuals outside of an outpatient setting leaving these appointments to detect lysis/loosening in asymptomatic individuals, which may seldom occur after one-year post surgery.(1) Most long-term studies, retrospectively assess clinic appointments via cohorts of revision surgery patients. However, these do not capture all arthroplasty patients nor reflect the cost of these clinics. It is yet unknown, in a tertiary level Australian hospital, whether arthroplasty clinics are a cost-effective measure.

Research design: The study will be a retrospective cohort of the arthroplasty clinic at our hospital over the last ten years. This will set the base for an ongoing prospective study. The aim is to collect patient demographics, type of surgery, time of follow up and outcome of the appointment. The study will exclude fractures and previously infected patients.

Statistics: Economic statisticians will be involved to calculate the cost effectiveness of arthroplasty clinic. Descriptive statistics will be used to identify the rate of asymptomatic complications found through the clinic per year.

Significance: This project will highlight the current utility of conventional arthroplasty clinic appointments at a tertiary level hospital over a 10-year period and develop a guide for post-operative follow-up. Given the need for arthroplasty surgery is ever growing, this project will provide great significance to orthopaedics in Australia.

Timetable plan: Data collection 12 months; Statistical analysis 1 month; Submit to ANZ journal of surgery 1-3 months.

References 1. Reynolds B, Maister N, Gill SD, Waring S, Schoch P, Beattie S, et al. Identifying complications requiring re-operation following primary hip or knee arthroplasty: a consecutive series of 98 patients. BMC musculoskeletal disorders. 2018;19(1):1-7.