HIT OR MISS ARTHROPLASTY

Abstract

1282 Primary total hip replacements were performed over the past 3 years at the Ravenscourt Park Hospital. Standardised post operative x-rays of the pelvis were archived on the Hammersmith Trust Picture Archiving and Communication System. 100 X-rays were randomly selected and reviewed by 3 independent observers (SHO, SPR, and a Consultant), and they were blinded as regards the Surgeon and their colleagues’ assessments. Surgeons who performed their procedure were excluded.

Digital radiographic analysis was performed using the OrthoView system (Meridian Technique Limited, Southamptom, UK). The acetabular component was studied with respect to cup version, the angle of inclination, the quality of cement technique, and the site of cup placement. The stems were studied for cementing technique and quality, stem alignment and limb length discrepancy. A hit was declared when excellence was achieved, whilst all others were declared as a miss. Inter observer rate in declaring a hit or miss was calculated (kappa). 58% of the radiographs studied were declared a hit, and 42% a miss.

All radiological reports were reviewed, and it was noted that no mention was made as regards the cup angles and the cementing quality. Each assessment took 3 minutes

(1.5). The aim of this post operative radiological assessment is to introduce a tool that could be used for appraisal of Surgeons, the surgical technique and for quality control.

The authors conclude that it is an easily reproducible technique, and can be performed by independent observers. These assessments will generate valuable data for research/auditing purposes, and act as an educational tool for trainees. They cautiously recommend this hit or miss approach, believing that it is a cost effective and efficient tool towards achieving better patient quality care and enhancing hip arthroplasty training skills.