Abstract
Following introduction of the second offer scheme in April 2004, Cardiff and Vale NHS Trust sent 227 patients (254 knees) to the independent sector treatment centre in Weston-Super-Mare for total knee arthroplasty. The Kinemax total knee system was used in all cases.
There was a perception that there were a large number of dissatisfied patients, and a previous British Orthopaedic Association report (of a 14 case sample) questioned the quality of the surgery performed.
All of the patients concerned were offered a review in order to assess the outcome. Of the 227 patients (254 knees), 77% have been reviewed (167 patients, 190 knees). 23% (59 patients, 64 Knees) have not been seen. Of these, 30 patients (34 knees) declined review on the basis that they were happy with the result of surgery. 14 Patients (15 knees) were unobtainable by post of by phone. A further 12 patients (12 knees) did not attend appointments. 3 Patients (3 Knees) had died.
The total number of re-operations was 27/254, giving a re-operation rate of 10.6%. There were 21 revisions, 17 for aseptic causes (oversized components, malalignment, aseptic loosening) and 4 for infection. There were 6 secondary patella resurfacings.
A life table survivorship analysis was calculated for the 254 knees. The cumulative survival rate at 3 years was 85.8%. These results are considerably worse than those reported in the current published literature. This has resulted in a significant economic impact on our service.
Correspondence should be addressed to Mr T Wilton, c/o BOA, BASK at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE, England.
