Arthroplasty

• Analysis on knee anterior cruciate ligament reconstruction
• Details on surface hip replacements
• Prolapsed disc surgery
• More detailed length of stay data
• More detail on elbow replacements
• Improvements made to clinical practice

KEY POINTS

• The number of primary total hip and knee arthroplasty procedures continues to increase (6,009 and 6,291 in 2006/07, respectively). For the first time, primary knee replacement procedures have outstripped primary hip replacement procedures. The number of knee replacements has tripled in the last 15 years (from 1,819 in 1991/92 to 6,291 in 2006/07).
• Surgeons and Health Boards are fully engaged with the process of monitoring complications of patients following hip and knee arthroplasty. Following the 2007 Annual Report, all consultants and Health Boards have investigated any rates of complication outside of the normal range, and all investigations were considered satisfactory or better by the Scottish Arthroplasty Committee.
• Overall, complication rates for deep vein thrombosis, dislocation, revision or death following hip and knee arthroplasty have reduced or remained stable. Most markedly, the rate of deep vein thrombosis following hip arthroplasty has reduced (from 0.0214% in 2001/02 to 0.0134% in 2006/07).
• For the first time, the Annual Report has looked at hip resurfacing procedures. This procedure was first recorded in 1995, and there has been a large increase in the number of such procedures (from 26 prior to 2002 to 240 in 2007). Of the 940 patients who have undergone this procedure in Scotland since 1995, only 17 have required a revision procedure, a rate of just 1.8%. It is typically being carried out on younger patients (64% were less than 55 years old; only 4% are 65 or over).

INTERPRETATION

• Within the independent sector there are an increasing number of patients who are undergoing hip or knee replacement operations under the waiting list initiative. These records are not reliably returned at present. As such, the Annual Report does not contain data on patients treated in the independent sector.
• It is hoped that the introduction of the new web-based system for collecting Scottish Joint Registry data will encourage the continual improvement in the quality of care provided to all patients receiving joint replacements. One independent sector hospital has recently submitted data to ISD, and other private hospitals have expressed an interest in joining the project. It should also allow independent sector hospitals to safely submit their data.

DETAILED FINDINGS

• The length of stay for hip replacements has decreased from an average of 12.7 days in 196/97 to 8 days in 2006/07. The length of stay for knee replacements has decreased from 13.2 days in 196/97 to 7.6 days in 2006/07.
• Individual anaesthetic departments are participating in the audit at a hospital level. Complications such as stroke, acute myocardial infarct, gastro-intestinal bleed and acute renal failure have been included in the report.
• Data on anterior cruciate ligament (ACL) reconstruction has been analysed for the 2008 Annual Report. There has been a large increase in the number of reconstructions performed (307 in 1997/98 to 677 in 2006/07). Reconstructions are more common in males than females (549 versus 128, and also men who are aged between 20 and 40 (424).
• Data on prolapsed disc surgery has been analysed for the 2008 Annual Report. This includes analyses on age, sex, volumes performed by Orthorpaedic versus non-orthorpaedic surgeons, and readmission with back complaint. There were 1,429 patients admitted for lumbar prolapsed disc problems in 2006/07, the most common being those aged 35-44 years old (488 admissions).