Abstract
A Physiotherapist-led Joint Replacement Surgery (JRS) Clinic was pioneered at the Royal Melbourne Hospital (RMH) Australia to improve the efficiency of the review process following hip and knee arthroplasty surgery and improve outpatient access to orthopaedic consultation. A credentialed physiotherapist conducted specified post-operative reviews in place of orthopaedic surgeons.
A protocol for the JRS Clinic was developed collaboratively by the Orthopaedic Surgery and Physiotherapy Departments at RMH. The orthopaedic surgeons conducted the initial 6 week post-operative review and the physiotherapist conducted subsequent reviews at 3, 6 and 12 months, and annually thereafter. Routine radiological imaging occurred immediately post-operatively, and at 1 year, 5 years, 10 years and then annually. Radiological credentialing allowed the physiotherapist to assess and manage patients independently. Collocation with the orthopaedic clinic facilitated immediate surgical input when required.
Between October 2009 and January 2011, 156 patients were offered a total of 246 appointments in the JRS clinic. This included 174 primary joint replacements (99 hip and 75 knee), 19 revisions (16 hip and 3 knee), and 3 re-surfaced hips. The attendance rate for the clinic was 82.9%. The physiotherapist discussed 20 cases with the surgeons with only 6 patients requiring transfer back to the Orthopaedic unit for ongoing management. Two of these patients have been wait-listed for revision surgery, 2 are undergoing further investigations and the remaining patients are yet to attend their scheduled review. Four patients declined further follow up in the JRS clinic. There were no adverse outcomes reported and no nursing input for wound issues was required. A patient survey demonstrated high levels of satisfaction with the service particularly related to improved access and time efficiencies.
Physiotherapist-led JRS Clinics in partnership with the Orthopaedic Surgery Department are an efficient and effective alternative model of care for the long term review of patients following arthroplasty surgery. The clinics assist in addressing the growing demand for arthroplasty services by increasing the surgeons’ capacity to manage new referrals.
