revision joint replacement

In an interesting new study published by the National Joint Registry (NJR), data has been shared showing a league table of the best- and worst-performing areas of the UK if you are considering an NHS hip replacement.

The assessment looked at 430 UK hospitals, comprising 145 NHS trusts running 250 hospitals in the UK, as well as 181 private hospitals.

The objective of this piece is not to name and shame hospitals that are underperforming, but rather to look at where the shortcomings are and to ensure that lessons are learned. That said the full list of the 10 worst-performing hospitals in the research can be accessed here.

Higher rates of revision joint replacement surgery tend to indicate that complications were most often due to infections taking hold after surgery or failures due to inadequate supervision of junior doctors.

Using medical data to improve practice

The positive outcome to take from this research is that it can be used to great benefit of the weaker performing hospitals. Those hospitals are able to use the data to look at why things are not going as well as expected and to help guide improvements. One of the weakest-performing hospitals in the report has already reported to be “ensuring supervision of non-consultant surgeons” as a direct result of this data. Another hospital reports having taken measures to combat higher than expected rates of infection following surgery, explaining that “measures had been introduced to reduce risks of cross-contamination, including ring-fencing beds used for planned surgery, and screening patients before operations.

All surgeons have data held by the National Joint Register on their practice and part of a surgeon’s appraisal process is to reflect on their results and, in particular, their complication rate. Every surgeon will have a complication rate as no surgery is without risk, but minimising the chance of complications occurring should always be the aim.

As with any data analysis, there are reasons behind the data that need to be assessed before the ‘true’ picture can be fully understood. Some of the weaker performing hospitals in this study report an older than average patient profile, which helps explain some of the patterns seen. The medical director of the NJR explains what this means for the report and the associated data “there are many potential reasons why a hospital may be found to have a higher revision rate than expected and the reason for drawing this matter to their attention is to encourage an urgent and thorough review of the hospital’s practice. There is an agreed process to enable appropriate action to be taken to review units which fall below expected performance thresholds.”

Reassuringly for Mr Bridle’s patients, his NJR data yields a positive picture, with low revision rates for both hip and knee replacement surgery. Not only that, on the whole, hip replacement surgery is a very successful type of operation and the vast number that are performed each year means that surgeons are able to continually advance techniques and reduce revision rates. Data in support of this shows that “patients can be reassured that the rates for revision joint replacement have fallen every year since 2011”.

Mr Simon Bridle will be able to discuss all the potential risks and benefits of a hip or knee replacement in full during a consultation. Call 020 8947 9524 to arrange.