THE IMPACT OF THE OSTEOARTHRITIS HIP AND KNEE SERVICE (OAHKS) IN MELBOURNE HEALTH: A REVIEW FROM 2006–2009

Abstract

Introduction: The OAHKS was introduced in 2006 and the aim of this service was to ensure early assessment and monitoring, optimise non-operative and pre-operative management, and ensure equitable access to surgical treatment. Patients were prioritized and monitored for disease deterioration using the Multi-Attribute Arthritis Prioritisation Tool (MAPT).

Methods: All patients who were referred for assessment by the OAHKS between December 2006 and April 2009 were identified. Data was collected from the OAHKS computer database, hospital patient information computer system and the Department of Health databases. Patients who underwent Joint replacement surgery (JRS) following pre-operative MAPT scores were identified. Demographic and clinical data was collected prospectively and statistically analysed. Demographic data included sex, age and ethnicity. Patient clinical data included referral source and time to initial OAHKS appointment, BMI, co-morbidities, MAPT scores, referrals to other healthcare professionals and outcome of OAHKS appointment.

Results: In total, 768 patients (296 males and 472 females) were referred to OAHKS between December 2006 and April 2009. Patients ranged in age from 20 to 94 years with a mean age of 68.22 years at initial review. Patients referred were from 20 different ethnic backgrounds. The median time to initial appointment was 80.5 days (IQR 36.5–99 days). 656 (85.4%) patients were referred from their GP and 89 referrals were from other sources. 89% patients (n=686) were screened for co-morbidities. Of these patients, 58% had hypertension, 20.8% had diabetes mellitus, 19.3% had ischaemic heart disease, and 19.8% had a psychosocial illness. The mean body mass index (BMI) was 32.71 (median 32.01). Only 42.3% patients had some form of conservative management modality prior to attending OAHKS. 1061 referrals to other healthcare professionals were made. Physiotherapy (48.6%), hydrotherapy (40%) and dietician (16.1%) were the commonest referrals. Referrals to the orthopaedic surgeon accounted for 15.7% total referrals. MAPT scores increased in 229 patients, decreased in 306 patients and were unchanged in 25 patients. From December 2006 – March 2009, 269 patients had MAPT scoring assessment pre-operatively. Of those patients who had surgery 52% had TKR, 40.5% THR, 5.5% UKR and 1.85% hip resurfacing.

Conclusion: The OAHKS has enabled patients with osteoarthritis to be rapidly assessed leading to a reduction in out-patient waiting times. Patients suitable for JRS are prioritised according to clinical need and MAPT scores, thus patients with greatest clinical need have received surgery much sooner than previously.