Abstract
GIRFT was published in the United Kingdom with the aim of streamlining primary care pathways, secondary care, creating a network of hospitals and treatment centres and to better regulate introduction of new implants. It also proposed the use of Orthopaedic Devices Evaluation Panel (ODEP) 10A* rated cemented implants in hip arthroplasty.
Aim: The purpose of this study was to assess the effects of adopting GIRFT on surgical time, length of stay, changes to the implants used and number of cases per surgical list.
Prior to adopting GIRFT, elective primary total hip replacement (THR) was predominantly uncemented THR. Age, sex, Body Mass Index (BMI), American Society of Anesthetiss (ASA), closure technique and surgical time of 50 consecutive primary uncemented THR were analysed to identify the appropriate statistical methods. Mean and standard deviation for surgical time were identified. Threshold increase in surgical time was set at 20 minutes. Based on expected difference of 20 minutes and standardised difference, minimum sample size was calculated to be 19. Prospective data on 60 consecutive uncemented THR and 30 consecutive cemented primary THR were included in this study. Inclusion criteria – primary THR for arthritis by single surgeon. Exclusion criteria – previous hip surgery, complex primary, abnormal anatomy.
No differences in age, sex, BMI, ASA and length of stay between the two groups. Surgical time was significantly increased by 28 minutes (p<0.001). Implants used changed from 7A*/5A* uncemented THR to 10A* (18/30) and 7A*(12/30) cemented THR. There was a reduction in number of THR done per surgical list due to the increase in surgical time (3 instead of 4).
GIRFT compliance improved from 0% cemented to 100% cemented. 0% 10A* rated implants to 66% 10A* rated implants. Undertaking cemented THR instead of uncemented THR is associated with significantly increased surgical time. Hence, number of THR surgeries performed in a day's list is accordingly reduced. There is potential for financial loss when the savings in the implants used is compared with the reduction in the number of surgeries performed.
