Safe follow-up of joint replacements

What is it about?

Total joint replacement is one of the successes of 20th century medicine, providing considerable improvement in quality of life to people suffering with severe joint pain. In 2017 over 200,000 total hip and knee replacements were conducted. The UK population is growing steadily older and more obese, and so the number of joint replacements performed each year is likely to continue to increase. Although joint replacement is an extremely successful procedure, sometimes problems can develop with the replaced joint over time, and in a small percentage of people further surgery is required. Follow-up care is provided to ensure that any problems are recognised as early as possible. Providing follow-up for all joint replacement patients in the years after their surgery places an enormous burden on the NHS, in addition to the huge cost for conducting the surgery itself. The NHS is under increasing pressure to reduce its costs and our recent survey work suggests that many hospitals have dramatically reduced the amount of follow-up provided to patients after surgery. Some hospitals no longer provide any follow-up care. There is currently very little research evidence to determine whether not providing follow-up care may cause harm to patients by missing the opportunity to pick up a problem with a replacement hip or knee joint before a catastrophic failure (fracture of the joint) occurs. Under the current system of follow-up such failure still occurs, more often in hip replacements than in knee, but there is no real understanding of whether this failure could have been prevented. This study will enable us to look at routine healthcare data (from primary and secondary care and from the National Joint Registry) on a large group of patients admitted for revision surgery. We will also collect data from patients when they have revision surgery to understand how they came to be admitted, including information about symptoms or previous hospital and GP visits. We will compare patients who needed emergency surgery due to catastrophic failure to those who have more timely revision surgery. This will help us to understand when people are most likely to develop problems with their joint replacement and to identify if certain people are more likely to develop problems than others. It is vital that a decision to stop providing follow-up is not made just to save costs to the NHS, but is based on precise evidence, which includes understanding potential benefit and harm to patients. At the end of the study an expert panel, including patients, will consider the results to develop guidelines about how follow-up should be conducted to ensure patients are not harmed.

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Why is it important?

This study has potential for huge impact, by reducing the burden on patients and the NHS in terms of outpatient visits and clinical tests that do not add benefit, while optimising detection of potential problems.

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