INTRODUCTION. Quality monitoring is increasingly important to support and assure sustainability of the Orthopaedic practice. Many surgeons in a non-academic setting lack the resources to accurately monitor quality of care. Widespread use of electronic medical records (EMR) provides easier access to medical information and facilitates its analysis. However, manual review of EMRs is inefficient and costly. Artificial Intelligence (AI) software has allowed for development of automated search algorithms for extracting relevant complications from EMRs. We questioned whether an AI supported algorithm could be used to provide accurate feedback on the quality of care following Total Hip Arthroplasty (THA) in a high-volume, non-academic setting. METHODS. 532 Consecutive patients underwent 613 THA between January 1. st. and December 31. st. , 2017. Patients were prospectively followed pre-op, 6 weeks, 3 months and 1 year. They were seen by the surgeon who created clinical notes and reported every adverse event. A random derivation cohort (100 patients, 115 hips) was used to determine accuracy. The algorithm was compared to manual extraction to validate performance in raw data extraction. The full cohort (532 patients, 613 hips) was used to determine its recall, precision and F-value. RESULTS. The algorithm had an accuracy value of 95.0%, compared to 94.5% for manual review (p=0.69). Recall of 96.0% was achieved with precision of 88.0% and F-measure of 0.85 for all adverse events. Recovery of 80.6% of patients was completely uneventful. Re-intervention was required in 1.3% of cases and 18.1% had a ‘transient’ event such as low back pain. The infection and dislocation rate was 0,3%. CONCLUSION. An AI supported search algorithm can analyze and interpret large quantities of EMRs at greater speed but with performance comparable to manual review. Using the program, new clinical information surfaced. 18.1% of patients can be expected to have a ‘transient’ problem following a THA procedure

We performed a case–control study to compare the rates of further surgery, revision and complications, operating time and survival in patients who were treated with either an uncemented hydroxyapatite-coated Corail bipolar femoral stem or a cemented Exeter stem for a displaced intracapsular fracture of the hip. The mean age of the patients in the uncemented group was 82.5 years (53 to 97) and in the cemented group was 82.7 years (51 to 99) We used propensity score matching, adjusting for age, gender and the presence or absence of dementia and comorbidities, to produce a matched cohort receiving an Exeter stem (n = 69) with which to compare the outcome of patients receiving a Corail stem (n = 69). The Corail had a significantly lower all-cause rate of further surgery (p = 0.016; odds ratio (OR) 0.18, 95% CI 0.04 to 0.84) and number of hips undergoing major further surgery (p = 0.029; OR 0.13, 95% CI 0.01 to 1.09). The mean operating time was significantly less for the Corail group than for the cemented Exeter group (59 min [12 to 136] vs 70 min [40 to 175], p = 0.001). The Corail group also had a lower risk of a peri-prosthetic fracture (p = 0.042; OR 0.19, 95% CI 0.01 to 1.42) . There was no difference in the mortality rate between the groups. There were significantly fewer complications in the uncemented group, suggesting that the use of this stem would result in a decreased rate of morbidity in these frail patients. Whether this relates to an improved functional outcome remains unknown.

Cite this article: Bone Joint J 2014;96-B:299–305.