Abstract
We have previously noted that patients undergoing primary knee arthroplasty can be broadly divided into standard and complex. Complexity can be further subdivided into local site of surgery issues, general co-morbidity problems or both.
On this basis, we devised a simple to apply four-part classification system for patients undergoing primary total knee replacecments (PTKR) to facilitate cumulative risk estimation:
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Complex 0 (C0): “Standard” knee replacement in a fit patient with a simple pattern of arthritis.
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Complex I (CI): A fit patient with a locally complex arthritis pattern.
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Complex II (CII): Medically unfit patient with a simple pattern of arthritis.
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Complex III (CIII): Medically unfit patient with a complex arthritis pattern.
When a series of consecutive PTKR’s performed by the senior author was grouped according to our classification, all early postoperative complications and length of stay were evaluated and compared.
Compared to “standard C0 PTKR patients, we found a 3-fold increase in the cumulative complication risk in the CII group (p< 0.001), a 4-fold increase in the CIII group (p< 0.001) and an increased length of stay in the CIII group (p< 0.001). There were similar trends between C0 and other groups.
Further local studies to quantify the cost differentials of treating complex patients and their longer term outcomes and satisfaction are underway.
The senior author would like to discuss with the attending members of this BASK meeting the desirability of adopting such a system regionally or nationally, with the potential benefits for individual patients, surgeons, departments, Trusts and the healthcare system as a whole, and whether minor changes could and should be made to the National Joint Registry forms to accommodate this.
Correspondence should be addressed to: Tim Wilton, BASK, c/o BOA, The Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE.
