There is sufficient evidence that specialised orthopaedic services, in the form of ‘hub’ or specialist centres, which undertake a high volume of workload in revision arthroplasty generate superior outcomes.

The East Midlands South Orthopaedic Network (EMSSON) was set up in 2015 and is an example of a ‘hub and spoke’ network. The network has recently undergone adaptation in light of the COVID-19 pandemic. There is paucity of data considering the impact of such adaptations in a post-pandemic era and on adherence to advice given.

Two data sets were obtained from the EMSSON data base, pertaining to pre and post pandemic eras respectively. Datasets were analysed and compared for case volumes, proportion of overall arthroplasty volume discussed and adherence to agreed management plans.

Dataset one included 107 cases, of these 99 cases were discussed (54 knees and 45 hips). This equates to 35% of total revision arthroplasty volume recorded in the National Joint Registry (NJR), by units involved in the network. A change of plan was recommended in 45/99 cases (45%), of these 41 (93%) were adhered to. Dataset two included 99 cases, of these 98 were discussed (39 knees and 59 hips). This equates 68% of revision arthroplasty volume performed by the region according to NJR records. A change in plan was recommended in 20 cases (20.5%), all of which were adhered to. One case was referred to the ‘hub’ for surgery.

Following the implementation of recent adaptations, the efficiency of the EMSSON network has significantly improved. A greater volume and proportion of revision arthroplasty cases are now being discussed on a weekly basis. Management plans for which adaptations are suggested have decreased, indicating an educational value of such networking practices. Adherence to agreed plans also showed improvement (p<0.03).

These findings demonstrate a trend towards NHS England's target of 100% of revision arthroplasty cases undergoing MDT discussion. Changes made in light of the Covid-pandemic, are felt to have contributed significantly to the overall performance of regional networking and have been well received by consultants involved.

Introduction

Renal impairment following major surgery is a formidable complication. There is recent evidence suggesting increasing risk of progression to chronic kidney disease and mortality after transient renal impairment. We aimed to evaluate the impact of pre-operative comorbidities on long-term outcomes of renal-function following hip arthroplasty.