Following a radiological review of total hip replacements in Gloucestershire, over a 15-month period, researchers were able to provide an insight into the quality of surgery, whether national guidelines were being followed, dislocation rates, as well as opportunities to deliver cost savings. STEFANO VERARDI, RACHEL MACKINNON and MICHAEL TREDGETT provide an overview of their findings.
In England and Wales there are approximately 80,000 total hip replacement procedures performed each year. These procedures are carried out in around 400 hospitals. One-third of these hospitals are managed by the independent sector and the remaining two thirds are state funded National Health Service hospitals, while two-thirds of the procedures are also funded by the NHS.1 These figures are important because of the funding they represent – nearly £300 million of taxpayer’s money is spent annually on hip replacements alone. The focus of our review of the quality of hip replacement surgery was the county of Gloucestershire, which has a population of around 600,000. Secondary NHS care in the county is provided by the Gloucestershire Hospitals NHS Foundation Trust, and the county is served by 20 full time equivalent consultant and seven staff grade or associate specialist orthopaedic surgeons. Total hip replacements (THR) comprise a significant proportion of the county’s elective workload. In 2006, a digital radiological service was implemented in the county – making it possible to assess many X-rays in a short period of time. Previously, it would have been impossible to manually access large numbers of X-ray films, due to audit resources and the time involved. With the barriers to conducting a large study removed, we felt it would be useful to audit hip replacement surgery in the county, which had never been performed on a large scale before. The aim was to generate a snapshot of hip replacement in the area, to assess the quality of the work performed, to allow consenting of patients to be undertaken with county-derived figures, and to see if national guidelines for implant use were being followed – given the enormous costs involved with the implants used.
Methods
We evaluated the immediate pre-operative and post-operative films of 866 patients, who were recorded as having had total hip replacement surgery between 2 January 2007 and 31 March 2008, for: • Dislocation rate. • Leg length discrepancy. • Implant type – femoral stem and acetabular cup. • Whether or not cement was used. • Quality of cementation. • Alignment of prostheses.
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