The National Joint Registry (NJR) was set up by the Department of Health to collect information on all joint replacements. The NJR data is externally validated against nationally collated Hospital Episode Statistics (HES). Errors associated with the use of HES data have been widely documented. We sought to explore the accuracy of the NJR data, for a single surgeon, against a prospectively collected personal logbook. The NJR and logbook were compared over a 3-year period (01/07/2009 to 30/06/2012). Total procedure recorded in the personal logbook was 684 and in the NJR was 681. TKR in personal log book was 304 and in NJR 316, revision knee's in personal logbook 45 and in NJR 36, THR 274 in personal logbook and 271 in NJR, revision hip procedures in personal logbook 64 and 58 in NJR. Whilst the total number of procedures captured correlates closely (681 vs 684) there is more variation with the different individual procedures. This may be due to the addition of 11% of HES data used for this time period by the NJR as it is known to be inaccurate. This therefore demonstrates the importance of maintaining your own accurate records.
The majority of orthopaedic surgeons routinely review their patients after six weeks, following surgery. During the first six weeks, orthopaedic surgeons are blissfully unaware of how frequently their patients seek medical attention related to problems with their arthroplasty. During this period of time, General Practitioners play a vital role in the care of the post-operative arthroplasty patient. The aim of this study was to determine how frequently patients seek medical attention following primary joint replacement in this interim six-week period. 102 patients from a single practice who had undergone a primary hip or knee replacement from 2003 to 2011 were included and the notes of all these patients were analysed retrospectively. Within this group there were 33 men and 69 women. 45 (44.1%) patients sought medical attention during the 6-week period, which accounted for 69 GP led interventions. The maximum number of interventions was four and a minimum of zero. Of these, 45 patients (29.4%) were seen once, 9 (8.8%) were seen twice, 3 (2.9%) were seen three times and 3 (2.9%) were seen four times. The interventions were for the following reasons: 1(0.9%) for post operative anaemia, 5 (4.9%) for constipation, (1.9%) for post operative nausea, 8 (7.8%) for leg pain (1 scanned for DVT), 5 (4.9%) for leg swelling (2 scanned for DVT), 12 (11.7%) were administered antibiotics, of which 1 was for a chest infection (1 scanned for DVT), 7(6.8%) for a wound review (1 scanned for DVT) (2 patients were started on antibiotic) and 19.6% (20) patients were seen for post operative analgesia. In total, there were 5 (4.9%) patients scanned for DVT and all scans were negative. GPs play a vital, often underestimated role in the post operative care of primary arthroplasty patients. The majority of interventions were required simply because of inadequate post-operative analgesia being given to patients upon discharge. This is an issue that the orthopaedic department can address, which will improve patient care and ease the burden on primary care. Patients still continue to see their GPs for suspected wound infections despite being instructed to contact the hospital. This issue needs to be addressed with further education, as any infection, even superficial, can have devastating consequences if it spreads to the prosthesis.
