PRIMARY TOTAL HIP REPLACEMENT: A COMPARISON OF A NATIONALLY AGREED GUIDE TO BEST PRACTICE AND CURRENT SURGICAL TECHNIQUE AS DETERMINED BY THE NORTH WEST REGIONAL ARTHROPLASTY REGISTER

Abstract

In 1999 a statement of best practice in primary total hip replacement was approved by the Council of the British Orthopaedic Association and by the British Hip Society to provide a basis for regional and national auditable standards. We have compared practice in the North West of England to this document to ascertain adherence to this guide to best practice.

86 surgeons from 26 hospitals were included in the study. A mean of 93.3% of operations were performed in the surgeon’s usual theatre. All of these theatres had vertical laminar air flow systems. 42.2% of respondents routinely used exhaust suits. 68.1% of respondents routinely used impermeable disposable gowns, 26.1% used impermeable reusable gowns. The Charnley femoral and acetabular prostheses were the most commonly used prostheses.

All surgeons use some form of anti-thromboembolic prophylaxis. 66.2% use a combination of both mechanical and chemical means. All surgeons used antibiotic prophylaxis. The most popular choice of antibiotic was a cephalosporin. 70.7% used a three-dose regime over 24 hours. 2.6% of surgeons continued antibiotic prophylaxis for 48 hours after surgery. 93.7% of surgeons routinely use antibiotic-loaded cement.All surgeons routinely cleaned, irrigated and dried the acetabulum and femur before cement insertion. Only one surgeon did not use any form of femoral canal occlusion. 69.4% used an intramedullary bone block. Retrograde filling of the femoral shaft by means of a cement gun was practised by 65.1%.

This study has demonstrated considerable variation of practice in THA across the North West region and significant divergence from the statement of best practice approved by the BOA and BHS. The introduction of a properly funded national hip register will surely help to clarify the effect of such diverse practice on patient outcome. We would recommend that all trusts locally audit their practices and correlate them to these nationally agreed guidelines.