Abstract
Abstract
Introduction
A revision knee replacement (rKR) network model has been introduced in the UK to improve clinical outcomes for patients and reduce healthcare costs. However, the current practice of different types of surgical unit is not well understood. The aim of this study was to answer: “How complex are rKR cases at a Major Revision Centre (MRC)?”
Methodology
Retrospective cohort study at the Nuffield Orthopaedic Centre, Oxford from 2015 - 2018. Case complexity was classified using the Revision Knee Complexity Classification (RKCC). Referral source, technical details of surgery and hospital admission impact were recorded.
Results
688 rKR procedures (380 rKR, 308 re-revision KR) were identified over the study period. 170 rKR (24.7%) were unplanned admissions requiring surgery, whilst the remaining cases were elective. 288/688 rKR (41.9%) were external referrals, where surgical complexity was rated ‘less complex’ (96 rKR, 33.3%), ‘more complex’ (92 rKR, 31.9%) and ‘most complex’ (100 rKR, 34.7%). 140/288 (48.6%) of these cases had one or more rKR prior to referral. Length of stay (LOS) was greater for more complex cases (R1 median 5 days [interquartile range 3–9], R2 median 9 days [IQR 5–15], R3 median 11 days [IQR 7–19]).
Conclusion
rKR complexity at the MRC followed a ‘rule of thirds’. Among external referrals, nearly half of patients had a previous rKR prior to referral. More complex cases required longer hospital admissions.
